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American travelers increasingly are selecting exotic destinations in the developing world. This poses a challenge to primary care clinicians who wish to provide recommendations to their patients regarding optimal protection from infectious disease risks. Recommendations should be individualized for each traveler and journey, accounting for personal health, health risks of specific destinations, style of travel, and activities anticipated. This article updates practitioners on the essentials of immunization before international travel.

In a study with 17,785 subjects obtained over the Internet from the United States and 47 other countries, Kinsey's hypothesis that sexual orientation lies on a continuum was supported. Self-identifications of subjects as gay, straight, bisexual, and other corresponded to broad, skewed distributions, suggesting that such terms are misleading for many people. Sexual orientation range—roughly, how much flexibility someone has in expressing sexual orientation—was also measured. The results support a fluid-continuum model of sexual orientation, according to which genetic and environmental factors determine both the size of the sexual orientation range and the point at which an individual's sexual orientation is centered on the continuum.

Background Healthcare-associated infections are a major source of morbidity and mortality in the United States. Infection Preventionists (IPs) are healthcare workers tasked at overseeing the prevention and control of these infections, but they may have difficulties obtaining up-to-date information, primarily in rural states. The objective of this study was to evaluate the importance of public health involvement on the knowledge-sharing network of IPs in a rural state. Findings A total of 95 attendees completed our survey. The addition of public health professionals increased the density of the network, reduced the number of separate components of the network, and reduced the number of key players needed to contact nearly all of the other network members. All network metrics were higher for public health professionals than for IPs without public health involvement. Conclusions The addition of public health professionals involved in healthcare infection prevention activities augmented the knowledge sharing potential of the IPs in Iowa. Rural states without public health involvement in healthcare-associated infection (HAI) prevention efforts should consider the potential benefits of adding these personnel to the public health workforce to help facilitate communication of HAI-related information.

Background Guidelines exist that recommend specific vaccines for health care personnel and supporting documents provide guidance for program development and implementation, but the extent to which those guidelines have been implemented in health care personnel immunization programs has not been fully explored. This project aimed to evaluate current practices in US health care facilities concerning health care personnel immunization programs. Methods A Web-based survey was deployed to 13,670 infection preventionists to assess 5 major program areas: (1) immunization program management; (2) vaccines provided to health care personnel; (3) vaccine handling practices; (4) training provided for the individual(s) responsible for the program; and (5) quality indicators for the program. A scoring scale was developed that demonstrated an overall measure of program performance. Results The Web-based survey resulted in 1,006 completed responses. When assessing overall program performance, the median vaccine program score was 47.6%. Respondents certified in infection prevention (CIC) scored significantly higher in overall program performance than respondents not certified (54% vs, 43%, respectively, P = .003). Conclusion Results of the survey have identified a number of education and training opportunities that can be addressed by professional associations using available evidence-based and proven implementation materials as resource documents.

To attempt to validate a previously reported clinical prediction rule derived to assist in distinguishing between acute bacterial meningitis and acute viral meningitis.Retrospective chart review of patients treated at five hospitals between 1981 and 1990. The criterion standard for bacterial meningitis was a positive cerebrospinal fluid (CSF) or blood culture or a positive test for bacterial antigen in the CSF. For viral meningitis, the criterion standard was a positive viral culture from CSF, stool, or blood or a discharge diagnosis of viral meningitis with no other etiology evident.Two Department of Veterans Affairs (VA) hospitals, two county hospitals, and one private hospital, each affiliated with one of two medical schools.All persons aged more than 17 years who were hospitalized over a ten-year period at one of five academically affiliated hospitals for the management of acute meningitis.Sixty-two cases of bacterial meningitis and 98 cases of viral meningitis were confirmed. With all patients included, the discriminatory power of the model as measured by the area under the receiver operating characteristic curve (AUC) was 0.977 (95% CI, 0.957-0.997), compared with the AUC of 0.97 in the derivation set of the original publication. The AUCs (95% CIs) for data subsets were: Dallas cases 0.994 (0.986-1.0). Milwaukee cases 0.912 (0.834-0.990); ages 18-39 years 0.952 (0.892-1.0), ages 40-59 years 0.99 (0.951-1.0), and ageor = 60 years 0.955 (0.898-1.0).The authors conclude that the clinical prediction rule proved robust when applied to a geographically distinct population comprised exclusively of adults. There was sustained performance of the model when applied to cases from each city and from three age strata. Prospective validation of this prediction rule will be necessary to confirm its utility in clinical practice.

The Paducah Gaseous Diffusion Plant (PGDP) became operational in 1952; it is located in the western part of Kentucky. We conducted a mortality study for adverse health effects that workers may have suffered while working at the plant, including exposures to chemicals.We studied a cohort of 6820 workers at the PGDP for the period 1953 to 2003; there were a total of 1672 deaths to cohort members. Trichloroethylene (TCE) is a specific concern for this workforce; exposure to TCE occurred primarily in departments that clean the process equipment. The Life Table Analysis System (LTAS) program developed by NIOSH was used to calculate the standardized mortality ratios for the worker cohort and standardized rate ratio relative to exposure to TCE (the U.S. population is the referent for ageadjustment). LTAS calculated a significantly low overall SMR for these workers of 0.76 (95% CI: 0.72-0.79). A further review of three major cancers of interest to Kentucky produced significantly low SMR for trachea, bronchus, lung cancer (0.75, 95% CI: 0.72-0.79) and high SMR for Non-Hodgkin's lymphoma (NHL) (1.49, 95% CI: 1.02-2.10).No significant SMR was observed for leukemia and no significant SRRs were observed for any disease. Both the leukemia and lung cancer results were examined and determined to reflect regional mortality patterns. However, the Non-Hodgkin's Lymphoma finding suggests a curious amplification when living cases are included with the mortality experience.Further examination is recommended of this recurrent finding from all three U.S. Gaseous Diffusion plants.

Hurricane Katrina of August 2005 forced more than one million people to evacuate the Gulf Coast of the United States. This study examines the psychological health and well-being of a subset of evacuees to determine the prevalence of ongoing mental health problems. Interviews were conducted with 101 adults who evacuated to Louisville, Kentucky, and were living in the state at the one-year anniversary of the event or had recently returned to the Gulf Coast. The psychological health and well-being of respondents was evaluated using several well-validated measures. More than one-half met the criteria for post-traumatic stress disorder and a majority were suffering from depression and anxiety. The mean quality of life score was 0.6 on a scale from 0-1, suggesting that adaptation and return to pre-hurricane well-being had not occurred 12 months after the storm. The potential for long-term psychological damage exists in this sample of Hurricane Katrina evacuees. Results suggest other evacuees may also be at heightened risk.

This is a report of brain cancer survival patterns in certain Area Development Districts (ADDs) in Kentucky, the state, and the nation. Brain cancer is of national and regional concern as it is a disease of high case fatality rates and relatively short survival. Comparisons for survival were made between the U.S.A. and the state. Kentucky has higher brain cancer mortality rates than the U.S.A., but significantly better cause-specific survival (p0.05). In order to examine within state variations for brain cancer survival, data organized for the fifteen ADDs from the state's central cancer registry were used. The analytic focus of this analysis were three regions expressly: the Purchase ADD (location of the Paducah Gaseous Diffusion Plant), the Green River ADD (the location of elevated brain cancer mortality rates), and the Kentucky River ADD (comprising counties that each have significantly more than the state average of persons living below the national poverty level). We found no evidence of lower survival for brain cancer among the poorer region of the state. The western districts were found to have lower cause-specific survival than the state (p0.05) and the U.S.A. Such a regional variation alerts population-based researchers to consider varying survival trends within the state's population.

The objective of this paper was to determine predictors of complementary and alternative medicine (CAM) use among individuals with specific health problems. Data were derived from the 1998 Medical Expenditure Panel Survey (MEPS). After adjustment for potential confounders, individuals with perceived barriers to obatining care were more likely to use any CAM treatment (OR 2.16), herbal therapy (OR 2.70) and spiritual care (OR 3.99) for a specific health problem. Individuals dissatisfied with their family's access to care were more likely to use acupuncture (OR 3.43). Dissatisfaction with quality of care was associated with increased use of spiritual therapy (OR 4.74). Perceptions of inadequate access to health care may contribute to utilization of CAM therapies; such therapies in this instance appear to be used as an alternative to mainstream medicine.

To establish rates of and risk factors for cardiac complications after noncardiac surgery in veterans.Prospective cohort study.A large urban veterans affairs hospital.One thousand patients with known or suspected cardiac problems undergoing 1,121 noncardiac procedures.Patients were assessed preoperatively for important clinical variables. Postoperative evaluation was done by an assessor blinded to preoperative status with a daily physical examination, electrocardiogram, and creatine kinase with MB fraction until postoperative day 6, day of discharge, death, or reoperation (whichever occurred earliest). Serial electrocardiograms, enzymes, and chest radiographs were obtained as indicated. Severe cardiac complications included cardiac death, cardiac arrest, myocardial infarction, ventricular tachycardia, and fibrillation and pulmonary edema. Serious cardiac complications included the above, heart failure, and unstable angina.Severe and serious complications were seen in 24% and 32% of aortic, 8.3% and 10% of carotid, 11.8% and 14.7% of peripheral vascular, 9.0% and 13.1% of intraabdominal/intrathoracic, 2.9% and 3.3% of intermediate-risk (head and neck and major orthopedic procedures), and 0.27% and 1.1% of low-risk procedures respectively. The five associated patient-specific risk factors identified by logistic regression are: myocardial infarction6 months (odds ratio [OR], 4.5; 95% confidence interval [CI], 1.9 to 12.9), emergency surgery (OR, 2.6; 95% CI, 1.2 to 5.6), myocardial infarction6 months (OR, 2.2; 95% CI, 1.4 to 3.5), heart failure ever (OR, 1.9; 95% CI, 1.2 to 3.0), and rhythm other than sinus (OR, 1.7; 95% CI, 0.9 to 3.2). Inclusion of the planned operative procedure significantly improves the predictive ability of our risk model.Five patient-specific risk factors are associated with high risk for cardiac complications in the perioperative period of noncardiac surgery in veterans. Inclusion of the operative procedure significantly improves the predictive ability of the risk model. Overall cardiac complication rates (pretest probabilities) are established for these patients. A simple nomogram is presented for calculation of post-test probabilities by incorporating the operative procedure.

Prayer is a behavior that is performed by most people at least at some time, and yet social scientists appear to have neglected this topic. College students were interviewed, given the Objective Measure of Ego Identity Status, and asked to keep 7-day diaries about their prayer activities, whether spontaneous or formal. Correlational analyses revealed a relationship between identity status and frequency of praying, as well as between identity status and commitment to religion. A qualitative analysis of the diary data suggested that prayer may be a revealing approach to the psychosocial lives of late adolescents, including their central concerns, temporal orientation, and the social bounds of their definition of self.

Varicella-zoster virus (VZV) transmission poses a major infection risk for health care workers in the hospital environment. Immunologically normal adults who contract varicella have 9 to 25 times the risk of major morbidity or death from infection compared with healthy children. Moreover, varicella infection during pregnancy is associated with a high rate of complications and the risk of the congenital varicella syndrome. To evaluate susceptibility to VZV infection among hospital workers, the employee health service screened 241 personnel for VZV antibody by the indirect fluorescent antibody technique. Overall, 7 (2.9%) of 241 personnel lacked VZV antibody and were therefore presumed susceptible to infection. Susceptibility varied dramatically by age and was significantly higher among persons 35 years of age and younger (7/93 = 7.5%) than among those aged 36 years and older (0/148 = 0%, p = 0.001). Persons 35 years old or younger with a clinical history of chickenpox or herpes zoster were much less likely to lack immunity (3/71 = 4.2%) than those stating they had no history of either (4/11 = 36.4%, p = 0.005). Screening strategies for VZV immunity in hospital employees could be made more efficient by performing serologic tests only on those persons aged 35 years or younger with a negative or uncertain history of the disease. Persons who lack antibody may be considered for preexposure immunization with live attenuated varicella vaccine as an alternative to varicella-zoster immune globulin or enforced absence from patient care after exposure to a VZV-infected patient.

When a subject fixates on a luminous design under conditions of low illumination, he experiences a fragmenting disappearance of the figure. This fragmentation occurs in meaningful units and is comparable to the disappearance of images stabilized on the retina. The luminous paint technique offers a new and simple approach to the study of visual perception.

(1968). The Development of Choice Stability in Children and Adolescents. The Journal of Genetic Psychology: Vol. 113, No. 1, pp. 79-83.