Confronting death from drug self-intoxication (DDSI): prevention through a better definition.

Suicide and other self-directed violence deaths are likely grossly underestimated, reflecting inappropriate classification of many drug intoxication deaths as accidents or unintentional and heterogeneous ascertainment and coding practices across states. As the tide of prescription and illicit drug-poisoning deaths is rising, public health and research needs would be better satisfied by considering most of these deaths a result of self-intoxication. Epidemiologists and prevention scientists could design better intervention strategies by focusing on premorbid behavior. We propose incorporating deaths from drug self-intoxication and investigations of all poisoning deaths into the National Violent Death Reporting System, which contains misclassified homicides and undetermined intent deaths, to facilitate efforts to comprehend and reverse the surging rate of drug intoxication fatalities.

The challenges were legion.

The search for the cause of the large outbreak of severe pneumonia that affected attendees of a convention of war veterans in Philadelphia in 1976 was complicated by a number of factors. The 2-10 day incubation period meant that cases were dispersed across Pennsylvania at time of onset, and matters were further complicated by the lack of a centralised record of attendance of the convention. Known methods for culture, serology, tissue staining, and toxicology gave negative results. The reliance on a clinical case definition, and the need to coordinate local, state, and federal jurisdictions both hindered efforts. Intense public scrutiny, anxiety, and promotion of implausible theories, researchers' memories of prior unsolved major investigations, and the inherent difficulty of documenting airborne spread also had an impact. The novel bacterial agent Legionella pneumophila was identified and its spread defined by persistent application of basic epidemiological and laboratory principles, including the willingness to re-examine one's assumptions.

Lack of observed association between armadillo contact and leprosy in humans

In 1971 it was discovered that the nine-banded armadillo (Dasypus novemcinctus) could be infected in the laboratory with Mycobacterium leprae, and would manifest disease similar to the lepromatous form of leprosy in man. In 1975 several wild armadillos captured in Louisiana were found to have a disease identical to the M. laprae infection in laboratory animals. To determine if there is a significant association between contact with armadillos and presence of leprosy in humans, the armadillo contact of persons with indigenous leprosy in Louisiana was compared to the contact of matched controls. No difference in the nature or frequency of contact was found. If this infection of wild armadillos is of recent onset, an association with human leprosy in enzootic areas may not be detectable for several years.