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1.
N Engl J Med ; 383(25): 2417-2426, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33176077

RESUMO

BACKGROUND: An outbreak of coronavirus disease 2019 (Covid-19) occurred on the U.S.S. Theodore Roosevelt, a nuclear-powered aircraft carrier with a crew of 4779 personnel. METHODS: We obtained clinical and demographic data for all crew members, including results of testing by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). All crew members were followed up for a minimum of 10 weeks, regardless of test results or the absence of symptoms. RESULTS: The crew was predominantly young (mean age, 27 years) and was in general good health, meeting U.S. Navy standards for sea duty. Over the course of the outbreak, 1271 crew members (26.6% of the crew) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by rRT-PCR testing, and more than 1000 infections were identified within 5 weeks after the first laboratory-confirmed infection. An additional 60 crew members had suspected Covid-19 (i.e., illness that met Council of State and Territorial Epidemiologists clinical criteria for Covid-19 without a positive test result). Among the crew members with laboratory-confirmed infection, 76.9% (978 of 1271) had no symptoms at the time that they tested positive and 55.0% had symptoms develop at any time during the clinical course. Among the 1331 crew members with suspected or confirmed Covid-19, 23 (1.7%) were hospitalized, 4 (0.3%) received intensive care, and 1 died. Crew members who worked in confined spaces appeared more likely to become infected. CONCLUSIONS: SARS-CoV-2 spread quickly among the crew of the U.S.S. Theodore Roosevelt. Transmission was facilitated by close-quarters conditions and by asymptomatic and presymptomatic infected crew members. Nearly half of those who tested positive for the virus never had symptoms.


Assuntos
COVID-19/epidemiologia , Surtos de Doenças , Transmissão de Doença Infecciosa/estatística & dados numéricos , Militares , SARS-CoV-2/isolamento & purificação , Navios , Adulto , Aeronaves , COVID-19/diagnóstico , COVID-19/mortalidade , COVID-19/transmissão , Teste para COVID-19 , Comorbidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Razão de Chances , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Estados Unidos
2.
BMC Public Health ; 11 Suppl 2: S7, 2011 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-21388567

RESUMO

The mission of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) is to support global public health and to counter infectious disease threats to the United States Armed Forces, including newly identified agents or those increasing in incidence. Enteric diseases are a growing threat to U.S. forces, which must be ready to deploy to austere environments where the risk of exposure to enteropathogens may be significant and where routine prevention efforts may be impractical. In this report, the authors review the recent activities of AFHSC-GEIS partner laboratories in regards to enteric disease surveillance, prevention and response. Each partner identified recent accomplishments, including support for regional networks. AFHSC/GEIS partners also completed a Strengths, Weaknesses, Opportunities and Threats (SWOT) survey as part of a landscape analysis of global enteric surveillance efforts. The current strengths of this network include excellent laboratory infrastructure, equipment and personnel that provide the opportunity for high-quality epidemiological studies and test platforms for point-of-care diagnostics. Weaknesses include inconsistent guidance and a splintered reporting system that hampers the comparison of data across regions or longitudinally. The newly chartered Enterics Surveillance Steering Committee (ESSC) is intended to provide clear mission guidance, a structured project review process, and central data management and analysis in support of rationally directed enteric disease surveillance efforts.


Assuntos
Surtos de Doenças/prevenção & controle , Gastroenteropatias/epidemiologia , Saúde Global , Medicina Militar , Vigilância de Evento Sentinela , Doenças Transmissíveis/epidemiologia , Previsões , Humanos , Incidência , Controle de Infecções , Laboratórios , Estados Unidos
3.
Mil Med ; 174(3): 259-64, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19354089

RESUMO

UNLABELLED: Physicians use multiple sources of information to search for answers to clinical questions. These sources include textbooks, journals, colleagues, and electronic resources, including the Internet. METHODS: To explore what sources are most commonly used by staff military physicians, we distributed a survey asking them to describe sources of medical information they used most frequently while in garrison and while on deployment. RESULTS: Most military physicians use the Internet to access medical information every day while in garrison. The frequency and pattern of use of medical resources differs while on deployment. The most common sources of electronic medical information are general Internet search engines (Google). Open-domain sites (PubMed and MEDLINE) are more commonly used by military surgeons, while filtered secondary information sources (UptoDate, MD Consult) appear to be more commonly used by military primary care physicians. Younger physicians use electronic resources more commonly than do older physicians. CONCLUSIONS: Knowing what sources of medical information military physicians use to search for answers to their clinical questions can help guide allocation of medical informatics resources, particularly to deployed military physicians providing in-theater care.


Assuntos
Acesso à Informação , Conhecimentos, Atitudes e Prática em Saúde , Internet , Informática Médica , Medicina Militar , Militares , Guerra , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estados Unidos
4.
US Army Med Dep J ; : 7-18, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23584903

RESUMO

In its 15th year, the Global Emerging Infections Surveillance and Response System (GEIS) continued to make significant contributions to global public health and emerging infectious disease surveillance worldwide. As a division of the US Department of Defense's Armed Forces Health Surveillance Center since 2008, GEIS coordinated a network of surveillance and response activities through collaborations with 33 partners in 76 countries. The GEIS was involved in 73 outbreak responses in fiscal year 2011. Significant laboratory capacity-building initiatives were undertaken with 53 foreign health, agriculture and/or defense ministries, as well as with other US government entities and international institutions, including support for numerous national influenza centers. Equally important, a variety of epidemiologic training endeavors reached over 4,500 individuals in 96 countries. Collectively, these activities enhanced the ability of partner countries and the US military to make decisions about biological threats and design programs to protect global public health as well as global health security.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Doenças Transmissíveis Emergentes/epidemiologia , Surtos de Doenças , Saúde Global , Medicina Militar/organização & administração , Vigilância de Evento Sentinela , Fortalecimento Institucional , Humanos , Laboratórios , Objetivos Organizacionais , Prevalência , Estados Unidos , United States Department of Defense
6.
News Physiol Sci ; 13: 170-176, 1998 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11390784

RESUMO

In hypertension caused by unilateral renal artery stenosis, the nonstenotic kidney becomes renin depleted but fails to prevent hypertension. The nonstenotic kidney mysteriously develops elevated intrarenal angiotensin II (ANG II) content. Rats chronically infused with ANG II exhibit a similar hypertensive process. The augmentation of intrarenal ANG II is due to receptor-mediated internalization and continued ANG II formation, which provide a hypertensinogenic stimulus.

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