Hepatitis C, diagnosis and management: a survey of practicing physicians in Hawaii.

We surveyed 652 Hawaii physicians who diagnosed hepatitis C (HCV) since 1997. Less than 20% of licensed physicians have diagnosed HCV and initial estimates suggest there are 12,000 to 18,000 undiagnosed HCV cases in Hawaii. Treatment is concentrated among twelve physicians and aggressive case finding may overwhelm present resources. More primary care physicians need to participate in the detection and management of HCV.

Bloodborne exposures at a United States Army Medical Center.

With the ultimate goal of minimizing exposures, we conducted a hazard analysis on bloodborne disease transmission at our hospital to identify appropriate control interventions. We utilized basic principles of occupational epidemiology to gather information on the severity and extent of exposures. Because we suspected inadequate reporting of needlestick injuries, we collected 339 reported exposures of health care workers; we conducted a survey of all workers requiring universal precautions training for bloodborne pathogens. The annual incidence of exposures reported was 93.7 per 1000 workers who required this training. Sharps accounted for 83.5 percent of these exposures. Exposure sources demonstrated 4.3 percent positive for HIV, 4.4 percent positive for hepatitis B, and 7.1 percent positive for hepatitis C. The survey indicated that blood/body fluid exposures were underreported by at least fourfold. House officers were most at risk. At-risk behaviors were identified by the significant differences in knowledge of HIV transmission and work practices between groups reporting no or single exposures versus groups reporting multiple exposures. Increased emphasis should be placed on education, reporting exposures, and training house officers in procedures requiring the use of hollow bore needles. This study shows how the use of occupational epidemiology principles and methods were utilized in conducting a thorough hazard analysis and in identifying appropriate control methods.

William Crawford Gorgas. He set the standard of military preventive medicine.

William C. Gorgas spent the first twenty years of his career dedicated to the daily tasks of rural patient care. When assigned to Havana, his practicable application of Walter Reed's demonstration of Yellow Fever transmission resulted in the elimination of Yellow Fever within eight months. His perseverance in applying principles of arthropod born disease control allowed the completion of the Panama Canal. He developed the Sanitation Corps, presently Army Environmental Health Services, and initiated emphasis on preventive medicine for the soldier. He served as the Surgeon General of the Army during World War I, when for the first time in our history fewer soldiers died from disease than from combat casualties.

Respiratory protection in occupational health-update.

Respiratory protection is a complex field involving industrial hygiene, physics, physiology, toxicology, medicine, anthropology, engineering, law, and worksite administration. Although the use of respirators is widespread, they are the least effective and often the most costly method of protecting workers. Preferred methods of protection are engineering controls that eliminate exposure and substitution of the agent for one of lesser toxicity. However, in work situations where alternative methods are not available, a well-designed and well-monitored respiratory protection program can still provide a safe environment for the soldier and civilian worker. With the enactment and enforcement of the Occupational Health and Safety Act, worker protection has gained a much higher priority among employers and health officials. The field is dynamic and some of the medical screening procedures outlined in TB MED 502 (Respiratory Protection) are outdated. Industrial processes and state-of-the-art protective equipment change rapidly. Because certified occupational health physicians and nurses are not always available, health care workers need a fundamental understanding of respiratory protection.

Operation tropic refuge: the East Wood rescue.

The U.S. Coast Guard rescued 525 Chinese nationals and ten Indonesian crewmen from the disabled motor vessel East Wood. They were participating in a human smuggling operation. Subjected to a trying ordeal at sea, these individuals were at great risk to life and health but survived remarkably well because of their good health, age, and mutual cooperation. The U.S. military organized the joint task force, Operation Provide Refuge, to provide humanitarian aid. The task force rapidly mobilized resources to support camp development on Kwajalein Island and provide nutrition and health care to the stranded travelers. Preventive Medicine personnel, called in at the beginning of the operation, helped develop a healthy campsite, which contributed to a relatively uneventful refugee experience. Close liaison with the local medical resources on Kwajalein was essential to the success of the operation.

Comparative effects of naproxen and aspirin on fever in children.

The antipyretic effect of single doses of naproxen, 2.5 mg/kg or 7.5 mg/kg, was compared to that of aspirin, 15 mg/kg, and of a placebo in a double-blind study. Febrile children, hospitalized overnight, were randomly assigned to one of the treatment or placebo groups, and their temperatures were recorded hourly. Naproxen, 7.5 mg/kg, was at least as effective as aspirin in onset of action and reduction of fever, and had a longer duration of action. Each of the three treatments had a significant effect as compared to that of the placebo. There was no difference in the total incidence of side effects among the four groups, but mild gastrointestinal complaints were more common among the patients in the high-dose naproxen group, whereas CNS complaints were more prevalent among the patients in the placebo group.

Neonatal electroencephalographic patterns as affected by maternal drugs administered during labor and delivery.

Effects of drugs used during labor and delivery on spontaneous (resting) and evoked brain electrical activity were studied in 45 normal human newborns 48 hours after delivery. Mothers received either anesthesia (general plus local) alone (group 1), anesthesia plus meperidine (group 2), anesthesia plus meperidine and promethazine (group 3), or anesthesia plus meperidine and diazepam (group 4). Autoregressive spectral analyses and subsequent stepwise discriminant analyses showed no differences in spontaneous brain electrical activity in the infants related to the type of drugs given to the mother. However, when auditory stimuli were reduced in intensity from 80 dB to 63 dB, a significant effect was found in newborn brain electrical activity between the anesthetic-only drug pattern (group 1) and the drug patterns of anesthetics with meperidine (group 2) and anesthetics with meperidine plus diazepam (group 4). The data suggest that this effect diminishes in the presence of promethazine (group 3). Evoked responses to visual, tactile, and olfactory stimuli remained unaffected.