50th anniversary historical article. Myocardial infarction and coronary care units.
The results of treatment of 250 patients with established acute myocardial infarction in a coronary care unit in a university hospital are described. The criteria for diagnosis have been carefully defined. In 62 percent of patients admitted with a tentative diagnosis of acute infarction, the initial impression was confirmed. Fifteen percent of patients admitted to the unit were classified as having possible infarction; in this group, the mortality rate was 3 percent. A classification of functional severity based on clinical evidence of heart failure or shock is presented. Morbidity and mortality in acute myocardial infarction are related to the functional severity of the illness. Although arrhythmia is common, the overriding importance of five life-threatening arrhythmias is emphasized. Mortality of patients in the coronary care unit was not improved in comparison to those treated under regular care until strong central direction of therapeutic programs, immediate treatment of arrhythmia in cardiac arrest, and delegation of some medical authority to trained nurses was accomplished. The change in concept of the purposes and practices of special coronary care from resuscitation to prevention of arrhythmia is emphasized. The mortality in myocardial infarction complicated by shock remains high. In the absence of shock, aggressive medical treatment in the coronary care unit reduced mortality from 26 to 7 percent. The implications of these data in the management of patients admitted to a hospital with a diagnosis of acute myocardial infarction are discussed. (+info)
50th anniversary historical article. Acute coronary syndromes: the degree and morphology of coronary stenoses.
In 110 patients with either stable or unstable angina, the morphology of coronary artery lesions was qualitatively assessed at angiography. Each obstruction reducing the luminal diameter of the vessel by 50% or greater was categorized into one of the following morphologic groups: concentric (symmetric narrowing); type I eccentric (asymmetric narrowing with smooth borders and a broad neck); type II eccentric (asymmetric with a narrow neck or irregular borders, or both); and multiple irregular coronary narrowings in series. For the entire group, type II eccentric lesions were significantly more frequent in the 63 patients with unstable angina (p less than 0.001), whereas concentric and type I eccentric lesions were seen more frequently in the 47 patients with stable angina (p less than 0.05). Type II eccentric lesions were also present in 29 of 41 arteries in patients with unstable angina compared with 4 of 25 arteries in those with stable angina (p less than 0.0001) in whom an "angina-producing" artery could be identified. Therefore, type II eccentric lesions are frequent in patients with unstable angina and probably represent ruptured atherosclerotic plaques or partially occlusive thrombi, or both. A temporary decrease in coronary perfusion secondary to these plaques with or without superimposed transient platelet thrombi or altered vasomotor tone may be responsible for chest pain in some of these patients with unstable angina. (+info)
Public health aspects of the Rainbow Family of Living Light annual gathering--Allegheny National Forest, Pennsylvania, 1999.
The Rainbow Family of Living Light (RFLL) is a loosely organized group that developed out of the late 1960s counterculture movement. RFLL has had a 2-week "Gathering for World Peace and the Healing of the Earth" in a different national forest each summer since 1972. For the June 21-July 10, 1999, gathering, RFLL selected the Allegheny National Forest in Pennsylvania. The site was not accessible by vehicle and was an hour's walk to the nearest road. No sanitary facilities were available, and water from streams was consumed without treatment. Approximately 20,000 persons attended from the United States and several foreign countries. The state health department requested federal assistance to establish and maintain public health surveillance and to advise on outbreak prevention and control. This report describes the public health aspects of the gathering and presents recommendations for the management of health risks at large outdoor events. (+info)
Update: outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000--Borneo, Malaysia, 2000.
During September 7-11, 2000, CDC was notified by the Idaho Department of Health, the Los Angeles County Department of Health Services, and the GeoSentinel Global Surveillance Network of at least 20 cases of acute febrile illness in three countries; all ill patients had participated in the Eco-Challenge-Sabah 2000 multisport expedition race in Borneo, Malaysia, during August 21-September 3, 2000. Participants included athletes from 29 U.S. states and 26 countries. This report updates the ongoing investigation of this outbreak through December 2, which suggests that Leptospira were the cause of illness and that water from the Segama River was the primary source of infection. Participants in adventure sports and exotic tourism should be aware of potential exposure to unusual and emerging infectious agents. (+info)
Risk for meningococcal disease associated with the Hajj 2001.
Every year approximately two million pilgrims from more than 140 countries gather in Saudi Arabia for a pilgrimage to the holy places of Islam known as the Hajj. Coinciding with the Hajj pilgrimage during March 2000, Saudi Arabian health officials identified an outbreak of meningococcal disease; a substantial proportion of the isolates were the bacterial strain Neisseria meningitidis serogroup W-135. Four cases of meningococcal disease subsequently were identified among the estimated 15,000 pilgrims returning to the United States, their close contacts, and community. In addition, approximately 400 cases of meningococcal disease caused by N. meningitidis serogroup W-135 wereidentified worldwide during 2000. Whether an outbreak of meningococcal disease will recur in 2001 is unknown. (+info)
Earth Day plus 30 years: public concern and support for environmental health.
A clear majority of Americans are concerned about environmental threats to public health and do not want to weaken antipollution regulations. The strongest supporters for maintaining environmental regulations are affluent mainstream White suburban populations who are thriving economically, but support is also strong in every other major segment of the population. Overt attempts to weaken the basic regulations are unlikely, barring an obvious economic downturn that would cause a large proportion of the public to consider loosening standards in the belief that such changes would increase the number of available jobs. Given this context, environmental health was and will continue to be a core topic in the Journal. We will emphasize the nexus of environmental health and policy by publishing research, exemplary public health practice, and the views of key decision makers. (+info)
Update: assessment of risk for meningococcal disease associated with the Hajj 2001.
During late March and early April 2000, four cases of meningococcal disease caused by Neisseria meningitidis serogroup W-135 were identified among U.S. pilgrims returning from the Hajj in Saudi Arabia, their close contacts, and communities. These cases occurred as part of a larger epidemic in which approximately 400 cases caused by a similar and unusual strain were identified worldwide. The Hajj, an annual pilgrimage to the major holy places of Islam, is attended by approximately two million persons from approximately 140 countries, including an estimated 15,000 from the United States. (+info)
The Circuit Party Men's Health Survey: findings and implications for gay and bisexual men.
OBJECTIVES: This study examined characteristics of gay and bisexual men who attend circuit parties, frequency of and motivations for attending parties, drug use and sexual behavior during circuit party weekends, and use of risk reduction materials available at parties. METHODS: A cross-sectional survey was conducted among 295 gay and bisexual men from the San Francisco Bay Area who had attended a circuit party in the previous year. RESULTS: One fourth of the men reported a drug "overuse" incident in the previous year. Nearly all respondents reported use of drugs during circuit party weekends, including ecstasy (75%), ketamine (58%), crystal methamphetamine (36%), gamma hydroxybutyrate or gamma butyrolactone (25%), and Viagra (12%). Two thirds of the men reported having sex (oral or anal), 49% reported having anal sex, and 28% reported having unprotected anal sex during the 3-day period. An association was found between use of drugs and sexual risk behavior. Prevention materials were observed at party events by some men; however, relatively few men used the materials. Common motivations for attending the parties were "to listen to music and dance" and "to be with friends." CONCLUSIONS: Intensive, targeted health promotion efforts are needed for gay and bisexual men who attend circuit parties. (+info)