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The threat of bioterrorist actions against citizens of the United States has generated an extensive plan for detection and response involving several components of our health care system. It is […]

The precision and accuracy of symptoms and signs of influenza is reviewed. Clinical findings identify patients with influenza-like illness but are not particularly useful for confirming or excluding the diagnosis of influenza.

Until the mid-1990s, data on the smoking behavior of veterans were available only for small populations in select settings. Reports described the prevalence of smoking among outpatients as ranging between […]

Appendicitis is probably best diagnosed with a combination of physical exam and medical history. Appendicitis, or inflammation of the appendix, is a common cause of abdominal pain. It can lead to serious complications if the appendix ruptures. Pain can be poorly localized but is present in the right lower quadrant when inflammation is advanced. Guarding, rigidity, rebound tenderness and fever are also signs of appendicitis. Pain while moving the legs of a reclining patient can reveal irritation of muscles by the appendix., Appendicitis is a common cause of abdominal pain for which prompt diagnosis is rewarded by a marked decrease in morbidity and mortality. The history and physical examination are at least as accurate as any laboratory modality in diagnosing or excluding appendicitis. Those signs and symptoms most helpful in diagnosing or excluding appendicitis are reviewed. The presence of a positive psoas sign, fever, or migratory pain to the right lower quadrant suggests an increased likelihood of appendicitis. Conversely, the presence of vomiting before pain makes appendicitis unlikely. The lack of the classic migration of pain, right lower quadrant pain, guarding, or fever makes appendicitis less likely. This article reviews the literature evaluating the operating characteristics of the most useful elements of the history and physical examination for the diagnosis of appendicitis. JAMA. 1996;276:1589-1594

Medical residents and students who are directly offered the influenza vaccine at conferences and clinics are more likely to be vaccinated than those who are offered the vaccine by other methods. A total of 442 medical residents and students were sent a memorandum regarding vaccination, then half of the remaining unvaccinated individuals were sent a personal letter, half of the letter recipients received a telephone call, and the remaining unvaccinated individuals were directly offered vaccination at conferences and clinics. During the three weeks following the memorandum, 87 individuals (20%) were vaccinated. Five weeks after the letter, 61 individuals (34%) who received letters were vaccinated, compared to 30 individuals (17%) who did not receive letters. By the end of the study, 275 individuals (62%) were vaccinated, 29 (7%) refused and 138 (31%) did not receive the notices. The number of individuals who were vaccinated did not increase significantly after telephone notification. Ninety percent of the individuals offered the vaccine at conferences and clinics were vaccinated, and 10% refused.

The relationship between blood cholesterol and coronary heart disease (CHD) is well established. In an effort to reduce the risk of CHD, a low-cholesterol diet is recommended. More than half of all Americans have blood cholesterol levels exceeding the desired cutoff of 200 milligrams per deciliter. Although many people are willing to alter their diets to reduce CHD risk, it is not known whether average Americans who follow accepted dietary guidelines maintain an adequate supply of other essential nutrients. Using information compiled by the National Health and Nutrition Examination Survey (NHANES II), the diets of 296 participants over the age of 18 who were following a low-cholesterol diet were compared with those of 10,052 individuals not following any special diet. Adjusting for the confounding effects of age, sex, race, education, smoking and socioeconomic status, the dietary intakes were assessed by a 24-hour diet recall. The average length of time on the low-cholesterol diet was 147 weeks. The individuals following the low-cholesterol diet consumed 16 percent fewer calories, 25 percent less fat and 21 percent less cholesterol than the nondieters. The amounts of vitamin A, thiamine, riboflavin, niacin, calcium and iron were similar in both groups. The dietary intake of vitamin C was 18 percent higher in the group following the diet. The nutrient density (the amount of the nutrients per kilocalorie of food) for each vitamin and mineral was higher in the dieting group: 35 percent more vitamin A, 35 percent more thiamine, 30 percent more riboflavin, 27 percent more niacin, 60 percent more vitamin C, 14 percent more calcium and 15 percent more iron. Dieters consumed 27 percent more poultry, 39 percent more fish, 30 percent fewer eggs, and 15 percent less meat. Dieters were able to select foods with a high density of nutrients, which helped to maintain their intake of essential vitamins and minerals. People adhering to the guidelines of a low-cholesterol diet receive the recommended allowances of food and nutrients. Therefore, nutritional benefits can be obtained when low-cholesterol diets are followed correctly. (Consumer Summary produced by Reliance Medical Information, Inc.)

We investigated whether printed or videotaped information is more effective in enhancing colon cancer knowledge. Subjects (n = 1100) were randomized into three groups: to receive a booklet, view a videotape, or receive no intervention. Subjects receiving the intervention showed increased knowledge compared with control subjects (booklet = 23% and videotape = 26% vs no intervention = 3%). Findings suggest that personalized educational materials are effective in enhancing colon cancer knowledge. (Am J Public Health. 1994;84:119-121), Individually tailored print and videotape materials about colon cancer may increase knowledge among patients with limited literacy. Researchers assigned 1,100 patients to receive a specially prepared booklet, view a videotape or receive no instruction about colon cancer. The patients took a pretest, received intervention materials and took a posttest and a general achievement test. The difference between pretest and posttest scores for both the videotape and booklet groups were significantly higher than the comparison group. Patients receiving the booklet increased their scores by 23% and those receiving the videotape improved by 26%. In contrast, patients receiving no intervention increased their scores by only 3%. Researchers used achievement test scores to separate patients into high reading ability and low reading ability classes. Reading ability did not significantly affect the cancer knowledge of any intervention group.

Byline: Ronald M. Atlas, Richard D. Clover, W. Paul McKinney The revised international health regulations recognise the importance of shortening the time from a disease outbreak to its detection and notification to the international public health community so that effective responses that enhance global biosecurity can be taken. The new international health regulations aim at requiring countries to issue alerts early enough so that responses can be initiated in a timely manner. But these regulations represent a real challenge for achieving early detection and translating notification into effective public health actions that reduce the risks of mass casualties from emerging infectious diseases and bioterrorism. Coordinated early warning mechanisms to facilitate rapid recognition of a disease outbreak are needed so that an effective response within the medical and public health communities can be initiated. Effective training is essential for early recognition of rare biothreat diseases; such training needs to be realistic to achieve an effective response. Responder and system capabilities should be verified periodically through the use of full-scale exercises or virtual drills. Such training and skills are critical for achieving biosecurity.

ABSTRACT: We reviewed the use of Fisher's Exact Test in 71 articles published between 1983 and 1987 in six medical journals. Thirty-three of 56 selected articles did not specify use of a one- or two-tailed test, and 12 (36%) of these actually used the one-tailed test. Five (42%) of these 12 articles contained at least one table in which the standard significance level of P

Factors related to physician ordering of influenza immunization were determined by reviewing the medical records of 847 elderly clinic patients and surveying the 95 primary care physicians who managed their care. Vaccination was offered to 41 percent of eligible patients. The percentage offered vaccination varied from 0 to 90 percent depending on the physician. Physician offering of vaccine was unrelated to patient age, gender or race, perceived frequency of side effects or estimates of vaccine effectiveness. However, physicians were more likely to offer vaccine to patients who saw them on multiple visits (47 percent) than to other patients (39 percent). Physicians were also more likely to offer vaccination to patients vaccinated during the previous year (65 percent) than to other patients (35 percent).