RESUMEN
BACKGROUND: During summer 2009, a US Navy ship experienced an influenza-like illness outbreak with 126 laboratory-confirmed cases of pandemic influenza A (H1N1) 2009 virus among the approximately 2000-person crew. METHODS: During September 24-October 9, 2009, a retrospective seroepidemiologic investigation was conducted to characterize the outbreak. We administered questionnaires, reviewed medical records, and collected post-outbreak sera from systematically sampled crewmembers. We used real-time reverse transcription-PCR or microneutralization assays to detect evidence of H1N1 virus infection. RESULTS: Retrospective serologic data demonstrated that the overall H1N1 virus infection attack rate was 32%. Weighted H1N1 virus attack rates were higher among marines (37%), junior-ranking personnel (34%), and persons aged 19-24 years (36%). In multivariable analysis, a higher risk of illness was found for women versus men (odds ratio [OR] = 2.2; 95% confidence interval [CI]: 1.1-4.4), marines versus navy personnel (OR = 1.7; 95% CI, 1.0-2.9), and those aged 19-24 versus ≥ 35 years (OR = 3.9; 95% CI, 1.2-12.8). Fifty-three percent of infected persons did not recall respiratory illness symptoms. Among infected persons, only 35% met criteria for acute respiratory illness and 11% for influenza-like illness. CONCLUSIONS: Approximately half of H1N1 infections were asymptomatic, and thus, the attack rate was higher than estimated by clinical illness alone. Enhanced infection control measures including pre-embarkation illness screening, improved self-reporting of illness, isolation of ill and quarantine of exposed contacts, and prompt antiviral chemoprophylaxis and treatment might be useful in controlling shipboard influenza outbreaks.
Asunto(s)
Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/epidemiología , Adulto , Anticuerpos Antivirales/sangre , California/epidemiología , Brotes de Enfermedades , Femenino , Humanos , Subtipo H1N1 del Virus de la Influenza A/genética , Gripe Humana/sangre , Gripe Humana/virología , Masculino , Personal Militar/estadística & datos numéricos , Pandemias , Estudios Retrospectivos , Estudios Seroepidemiológicos , Adulto JovenRESUMEN
Despite the burgeoning research literature addressing spirituality and its measurements, few instruments have undergone rigorous reliability and validity testing. This study contributed to determining the reliability and validity of the 16- and 6-item Daily Spiritual Experiences Scale (DSES) in a convenience sample of African Americans ages 34-85. Data were collected via self-administered questionnaire including the DSES and sociodemographic variables thought to influence spiritual experiences. Data were analyzed using paired t-tests, ANOVA, inter-class correlation coefficients, Pearson's correlation, and Cronbach's alpha. Both versions were stable over time, internally consistent, and the forms were equivalent and valid in an all-African American sample.
Asunto(s)
Negro o Afroamericano/psicología , Psicometría , Religión , Espiritualidad , Encuestas y Cuestionarios , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estados UnidosRESUMEN
Obesity is epidemic in the modern world. It is becoming increasingly clear that obesity is a major cause of cardiovascular disease, diabetes, and renal disease, as well as a host of other comorbidities. There are at present no generally effective long-term medical therapies for obesity. Surgical therapy for morbid obesity is not only effective in producing long-term weight loss but is also effective in ameliorating or resolving several of the most significant complications of obesity, including diabetes, hypertension, dyslipidemia, sleep apnea, gastroesophageal reflux disease, degenerative joint disease, venous stasis, pseudotumor cerebri, nonalcoholic steatohepatitis, urinary incontinence, fertility problems, and others. The degree of benefit and the rates of morbidity and mortality of the various surgical procedures vary according to the procedure.
Asunto(s)
Cirugía Bariátrica , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/epidemiología , Enfermedades Renales/epidemiología , Obesidad Mórbida/cirugía , Obesidad/cirugía , Cirugía Bariátrica/efectos adversos , Comorbilidad , Dislipidemias/epidemiología , Reflujo Gastroesofágico/epidemiología , Humanos , Hipertensión/epidemiología , Infertilidad/epidemiología , Artropatías/epidemiología , Obesidad/epidemiología , Obesidad/fisiopatología , Obesidad/psicología , Obesidad Mórbida/epidemiología , Obesidad Mórbida/fisiopatología , Obesidad Mórbida/psicología , Seudotumor Cerebral/epidemiología , Factores de Riesgo , Síndromes de la Apnea del Sueño/epidemiología , Incontinencia Urinaria/epidemiología , Pérdida de PesoRESUMEN
Obesity is pandemic in the modern world and continues to increase at an alarming rate, with great human and economic consequences. While bariatric surgery has been gaining popularity and acceptance as an effective way to achieve massive weight loss, it remains an option only for the extremely obese. For the millions of overweight and moderately obese individuals, the cornerstone of obesity treatment remains lifestyle and behavioral modifications in diet and physical activity. It is especially important for both primary care providers and subspecialists to be familiar with currently recommended approaches to the medical treatment of obesity, as it is critical that this extremely common, treatable chronic disease be recognized, intervention initiated, and therapy maintained at every appropriate clinical opportunity. Significant medical benefits can be gained even with a relatively small percentage of weight loss.