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The Comprehensive Clinical Evaluation Program is a US military program that provides a voluntary, clinically oriented evaluation for Gulf War health concerns. This article presents administrative data on psychological conditions (as coded using the International Classification of Diseases, 9th Revision) from the first year of the program. The most commonly diagnosed psychological conditions were medically unexplained physical-symptom syndromes; depression and anxiety, including post-traumatic stress disorder; and alcohol abuse or dependence. Psychological conditions were significantly related to a higher number of workdays lost, and the 19% of veterans with a primary diagnosis of a psychological condition reported 28% of the lost workdays among veteran who participated. Stressful Gulf War experiences were weakly but significantly related to psychological conditions. We conclude that among Gulf War veterans seeking evaluation for Gulf War-related health concerns, psychological conditions are common and are associated with important occupational morbidity.

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Estimates of the prevalence of various alcohol problems (DSM-III-R alcohol abuse/dependence, heavier drinking, and consuming 5 or more/9 or more drinks per occasion) were examined for a general population group of 29,155 persons age 18 years and older at self-reported risk for contracting AIDS by several definitions. All AIDS risk groups showed elevated risk for alcohol problems. Results are presented separately for males and females and for various demographic groups (age, marital status, family income, education, and race).

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Although most readers consider medical publications to be somber and somnifacient, a critical eye will discover a remarkable array of absurdities and assorted other oddities, totally unintended by the authors. These eccentricities can be attributed to failure of the author to engage the mind before activating the pen, a lapse of attention during preparation of the manuscript, or an effort to convey profundity and conceal vacuity by inflated and pompous language. The egregious examples from prestigious journals included here should alert medical authors that eternal vigilance to clear, orderly reasoning and lucid, orderly language is crucial during preparation of a manuscript. To acquire a pleasing and distinctive literary style, read extensively of the literary masters, approach writing with enthusiasm for its challenges and rewards, experiment with the choice and arrangement of words and phrases, and read critically every word, phrase, sentence, paragraph, and section of your manuscript as though you were your most critical adversary.

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Using alcohol-attributable fractions derived from studies of alcohol's involvement in various causes of death, this report presents trends in overall alcohol-related mortality for each year from 1979 through 1988. Age-adjusted rates show decreases in alcohol-related mortality for both sexes and for whites and nonwhites. Decreases occur for causes of death directly attributable to alcohol and for other diseases and injuries and adverse effects indirectly attributable to alcohol. Issues surrounding the use of currently available alcohol-attributable fractions for estimating alcohol-related mortality are discussed.

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Using data from the 1983 and 1988 National Health Interview Surveys, this note examines changes both in the prevalence of abstention and the prevalence of heavier drinking among drinkers in the United States. Changes are examined separately by gender and according to other sociodemographic characteristics often associated with different levels of alcohol consumption. Results suggest an increase in abstention and a decrease in heavier drinking between 1983 and 1988. For women, decreases in heavier drinking were found among those 18-44 years of age, among those employed, and among those divorced/separated or never married. For men, decreases in heavier drinking were found among those employed, among those with family income of $25,000 or more, and among those married or divorced/separated. Changes both in abstention and heavier drinking were found to vary considerably by geographical region. These findings do not support results from other general population survey studies on alcohol use that suggest a stability in drinking levels, or even a slight increase in heavier drinking among men.

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SCHOLARS, SCIENTISTS, PHYSICIANS, OTHER HEALTH PROFESSIONALS, AND LIBRARIANS FACE A CRUCIAL DECISION TODAY: shall we nourish the biomedical archives as a viable and indispensable source of information, or shall we bury their ashes and lose a century or more of consequential scientific history? Biomedical books and journals published since the 1850s on self-destructing acidic paper are silently and insidiously scorching on our shelves. The associated risks for scientists and physicians are serious-incomplete assessment of past knowledge; unnecessary repetition of studies that have already led to conclusive results; delay in scientific advances when important concepts, techniques, instruments, and procedures are overlooked; faulty comparative analyses; or improper assignment of priority. The archives also disclose the nature of biomedical research, which builds on past knowledge, advances incrementally, and is strewn with missteps, frustrations, detours, inconsistencies, enigmas, and contradictions. The public's familiarity with the scientific process will avoid unrealistic expectations and will encourage support for research in health. But a proper historical perspective requires access to the biomedical archives. Since journals will apparently continue to be published on paper, it is folly to persist in the use of acidic paper and thus magnify for future librarians and preservationists the already Sisyphean and costly task of deacidifying their collections. Our plea for conversion to acid-free paper is accompanied by an equally strong appeal for more rigorous criteria for journal publication. The glut of journal articles-many superficial, redundant, mediocre, or otherwise flawed and some even fraudulent-has overloaded our databases, complicated bibliographic research, and exacerbated the preservation problem. Before accepting articles, journal editors should ask: If it is not worth preserving, is it worth publishing?It is our responsibility to protect the integrity of our biomedical records against all threats. Authors should consider submitting manuscripts to journals that use acid-free paper, especially if they think, as most authors do, that they are writing for posterity. Librarians can refuse to purchase journals published on acidic paper, which they know will need restoration within a few decades and will thus help deplete their budgets. All of us can urge our government to devise a coordinated national conservation policy that will halt the destruction of a century of our historical record. The battle will not be easy, but the challenge beckons urgently. The choice is ours: we can answer the call, or we can deny scientists, physicians, and historians the records they need to expand human knowledge and improve health care.

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When you have completed the first draft of your manuscript, put it aside for a couple of weeks before you begin your critical review and revision, so that you will examine it with a fresh eye and renewed interest. Read your composition several times, concentrating on a specific criterion each time. Begin with the general principles of originality and validity; next move to structure and organization, then to grammatical propriety and usage, and finally to readability. Sensitize yourself to the recurrent maladies in medical writing--the verbosity, jargon, imprecision, barbarisms, stereotypy, illogical locutions, improper sequence of tenses, and generally unappealing style. Remember, you are writing to convey an important message, so make sure your style and form illumine rather than eclipse or becloud that message.

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A case report, if prepared properly, is a valuable educational device to describe an unusual clinical syndrome, association, reaction, or treatment. If a case advances basic understanding of a disorder, increases clinical skill, or suggests useful research, it is worthy of publication. Conciseness is paramount. The description of the case should contain only pertinent positive and negative findings. Irrelevant material or excessive detail can obscure the essence of a report and repel editors and readers. The discussion should emphasize the salient features of the case, show their relation to previous knowledge, interpret their significance, draw conclusions or generalizations about future cases when warranted by the evidence presented, or suggest further possible studies. Information withheld by the patient and unjustified speculation can nullify the value of a case report. Illustrations add visual appeal and enhance the educational value of a report. Tables and graphs should reduce any statistical data to readily interpretable form. All visual supplements should be simple, compact, and self-contained. Appropriate documentation is desirable, but only essential citations need be included, and the author should have carefully reviewed and verified all references used. Begin with a clear title and end with an informative Summary. A useful case report is factual, concise, logically organized, clearly presented, and readable. The three primary principles to remember: (1) Make sure the case warrants publication. (2) Include only pertinent information. (3) Be concise.

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