[Naval contributions at the beginning of the tropical medicine research in the 19th century]. / Aportes navales al inicio de la investigación en medicina tropical en el siglo XIX.

In the second half of the 19th century, the beginning of the research on tropical medicine was favored with contributions from shipping companies, like Dutch East India Company, being perhaps the most important of these its collaboration in the creation of the China Imperial Maritime Customs Service (1854-1950), imposed by consuls from England, France and USA, on the weak Chinese government in order to establish regular taxes in all its ports, soon expanding its functions with reports on tides, typhoons and weather, ending up creating a medical service in 1863 to detect epidemics and establish quarantines. This medical service published a Journal, the Imperial Maritime Customs Medical Reports, where they wrote distinguished investigators, such as Patrick Manson, Father of Tropical Medicine. We comment in some reports of this journal, to get an idea about its real importance in the development of tropical medicine.

Aportes navales al inicio de la investigación en medicina tropical en el siglo XIX / Naval contributions at the beginning of the tropical medicine research in the 19th century

Resumen En la segunda mitad del siglo XIX, el inicio de la investigación en medicina tropical se vio favorecido con aportes de empresas navieras, como la Compañía Holandesa de las Indias Orientales, siendo quizás el más importante su gestión apoyando la creación en China del Servicio Marítimo Imperial de Aduanas (1854-1950), impuesto al débil gobierno chino por los cónsules de Inglaterra, Francia y EEUU, para establecer tasas regulares en todos sus puertos, que pronto amplió sus funciones a la información de mareas, tifones y clima, terminando por crear en 1863 un Servicio Médico para detectar epidemias y establecer cuarentenas. Este Servicio Médico editó una revista, Medical Reports, en la cual publicaron distinguidos investigadores, como Patrick Manson, Padre de la Medicina Tropical. Comentamos algunos informes aparecidos en ella, para conocer su real importancia en el desarrollo de la medicina tropical.

Abstract In the second half of the 19th century, the beginning of the research on tropical medicine was favored with contributions from shipping companies, like Dutch East India Company, being perhaps the most important of these its collaboration in the creation of the China Imperial Maritime Customs Service (1854-1950), imposed by consuls from England, France and USA, on the weak Chinese government in order to establish regular taxes in all its ports, soon expanding its functions with reports on tides, typhoons and weather, ending up creating a medical service in 1863 to detect epidemics and establish quarantines. This medical service published a Journal, the Imperial Maritime Customs Medical Reports, where they wrote distinguished investigators, such as Patrick Manson, Father of Tropical Medicine. We comment in some reports of this journal, to get an idea about its real importance in the development of tropical medicine.

Scientific evidence of dockworker illness to nursing clinical reasoning.

OBJECTIVE: To identify scientific evidence of occupational illness of dockworkers published in the literature. METHOD: systematic review of the literature, developed according to the Cochrane method. The databases searched were: Cochrane, LILACS, MEDLINE/PubMed, CINAHL and SciELO. Studies from 1988 to 2014 were selected. The data were analyzed according to the level of evidence and Strengthening the Reporting of Observational Studies in Epidemiology. RESULTS: We included 14 studies, in which 11 (78.6%) were from international journals. The year of 2012 showed greater number of studies. All studies were classified as: Level of Evidence 4, highlighting lung cancer, musculoskeletal and ischemic diseases, causal link in chemical risks. CONCLUSION: The development of preventive measures should especially include chemical exposure of workers applying the clinical reasoning of nurses' environmental knowledge to care for illnesses. OBJETIVO: Identificar evidências científicas de adoecimento ocupacional do trabalhador portuário publicadas na literatura. MÉTODO: Revisão sistemática da literatura, construída conforme o método Cochrane. As bases de dados pesquisadas foram Cochrane, LILACS, MEDLINE/PubMed, CINAHL e SciELO. Foram selecionados artigos publicados de 1988 a 2014. Os dados foram analisados conforme o Nível de Evidência e Strengthening the Reporting of Observational Studies in Epidemiology. RESULTADOS: Foram selecionadas 14 publicações, das quais 11 (78,6%) de revistas internacionais. O ano de 2012 reuniu maior número de publicações no período de estudo. Todas as publicações pertenciam ao Nível de Evidência 4, destacando o câncer pulmonar, doenças osteomusculares e isquêmicas, com nexo causal nos riscos químicos. CONCLUSÃO: A elaboração de medidas preventivas deve prever especialmente a exposição química do trabalhador, aplicando ao raciocínio clínico do enfermeiro um conhecimento ambiental para a assistência aos adoecimentos.

Scientific evidence of dockworker illness to nursing clinical reasoning / Evidencias científicas de enfermización del trabajador portuario para el razonamiento clínico de la enfermería / Evidências científicas de adoecimento do trabalhador portuário para o raciocínio clínico da enfermagem

Abstract OBJECTIVE To identify scientific evidence of occupational illness of dockworkers published in the literature. METHOD systematic review of the literature, developed according to the Cochrane method. The databases searched were: Cochrane, LILACS, MEDLINE/PubMed, CINAHL and SciELO. Studies from 1988 to 2014 were selected. The data were analyzed according to the level of evidence and Strengthening the Reporting of Observational Studies in Epidemiology. RESULTS We included 14 studies, in which 11 (78.6%) were from international journals. The year of 2012 showed greater number of studies. All studies were classified as: Level of Evidence 4, highlighting lung cancer, musculoskeletal and ischemic diseases, causal link in chemical risks. CONCLUSION The development of preventive measures should especially include chemical exposure of workers applying the clinical reasoning of nurses' environmental knowledge to care for illnesses.

Resumen OBJETIVO Identificar evidencias científicas de enfermización ocupacional del trabajador portuario publicadas en la literatura. MÉTODO Revisión sistemática de la literatura, planteada conforme al método Cochrane. Las bases de datos investigadas fueron Cochrane, LILACS, MEDLINE/PubMed, CINAHL y SciELO. Fueron seleccionados artículos publicados de 1998 a 2014. Los datos fueron analizados conforme al Nivel de Evidencia y Strengthening the Reporting of Observational Studies in Epidemiology. RESULTADOS Fueron seleccionadas 14 publicaciones, de las que 11 (78,6%) fueron de revistas internacionales. El año del 2012 reunió mayor número de publicaciones en el período de estudio. Todas las publicaciones pertenecían al Nivel de Evidencia 4, destacando el cáncer pulmonar, las enfermedades osteomusculares e isquémicas, con nexo causal en los riesgos químicos. CONCLUSIÓN La elaboración de medidas preventivas debe prever especialmente la exposición química del trabajador, aplicando al razonamiento clínico del enfermero un conocimiento ambiental para la asistencia a las enfermizaciones.

Resumo OBJETIVO Identificar evidências científicas de adoecimento ocupacional do trabalhador portuário publicadas na literatura. MÉTODO Revisão sistemática da literatura, construída conforme o método Cochrane. As bases de dados pesquisadas foram Cochrane, LILACS, MEDLINE/PubMed, CINAHL e SciELO. Foram selecionados artigos publicados de 1988 a 2014. Os dados foram analisados conforme o Nível de Evidência e Strengthening the Reporting of Observational Studies in Epidemiology. RESULTADOS Foram selecionadas 14 publicações, das quais 11 (78,6%) de revistas internacionais. O ano de 2012 reuniu maior número de publicações no período de estudo. Todas as publicações pertenciam ao Nível de Evidência 4, destacando o câncer pulmonar, doenças osteomusculares e isquêmicas, com nexo causal nos riscos químicos. CONCLUSÃO A elaboração de medidas preventivas deve prever especialmente a exposição química do trabalhador, aplicando ao raciocínio clínico do enfermeiro um conhecimento ambiental para a assistência aos adoecimentos.

Los cuerpos militares como hito social del cuidado para la enfermería naval / Military bodies as a social milestone of care for naval nursing

En las últimas décadas la enfermería en México ha realizado investigaciones que buscan recuperar su identidad disciplinar con base en la historiografía de distintos gremios de enfermeras indagando sobre sus orígenes y antecedentes históricos para definir los elementos ontológico y epistemológicos que les caracterizan. Tal es el caso de la Enfermería Naval que a través de su historia, describe la evolución profesional como gremio, con el objetivo de construir la primera historiografía sobre la formación de enfermeras navales en el medio militarizado, contribuyendo a su vez con el acervo histórico de la enfermería en México. La historia de este gremio se construyó con base en la fenomenología descriptiva e interpretativa, para ello se efectuó análisis de contenido de fuentes históricas documentales, periódicos, fotografías, videos, microfilms, entrevistas a profundidad e inclusive una historia de vida, entre las cuales se categorizaron temas y subtemas definiendo como ejes teóricos: los orígenes de la sanidad en el ejército, la iniciación de la enfermería en la Armada y la evolución de las enfermeras navales al servicio de sus milicias. Los resultados han revelado que los cuidados de enfermería hacia las milicias marítimas en México, datan desde el siglo XVIII principalmente en los puertos de Veracruz y Acapulco; así también, que a lo largo del siglo XX mediante fenómenos sociales como: la profesionalización de los marinos militares, la Segunda Guerra Mundial, el crecimiento económico de la zona marítima mexicana, la proporción de ayuda humanitaria a población en situación de catástrofe natural y el apoyo en los procesos de seguridad nacional, es como la enfermería naval mexicana ha evolucionado su práctica profesional. Se concluye que el gremio de enfermeras navales ha evolucionado en su disciplina, a través de estudiar, adaptar y articular su práctica profesional con su población de estudio que son los cuerpos militares marítimos, incrementando su nivel educativo a partir de la existencia de su escuela y consolidando su reconocimiento en el ámbito militar mediante la adaptación de sus cuidados en cuyo ambiente, representa la parte humana de la Armada de México.

On last decades the nursing in Mexico has done research with the intention of recovering its identity as a discipline based on the historiography of different nurses guilds, inquiring about their origins and historical background in order to define the ontologic and epistemological elements that characterize them. Such is the case of the Naval Nursing that through its history, describes the professional evolution as a guild, with the objective of building the first historiography about the formation of naval nurses inside the military scope, and at the same contributing with the nursing historical heritage of Mexico. The History of this guild was constructed based on the descriptive and interpretative phenomenology, for this was performed an analysis of the content of historical documental sources, newspaper, photographs, videos, microfilms, interviews in depth and even a life story, among which topics and subtopics were categorized, defining as theoretical axis: Origins of health in the army, the beginnings of the nursing in the Army and the evolution of the naval nurses to the services of their militias. The results have revealed that the nursing attentions toward the militias in Mexico dating mainly from the XVIII century in the Veracruz and Acapulco ports; also that along the XX century due to social phenomena as: the professionalization of the marines, the Second World War, the economic growth in the Mexican maritime area, the portion of humanitarian help given to the population at natural disaster and the support on the national security process, is how the Mexican naval nursing has evolved its professional practice. I conclude that the guild of the naval nurses has evolved in its discipline, through knowing, attending and articulating its professional practice with its study population which are the maritime military corps, increasing its educational level since the foundation of its school and consolidating its recognition in the military scope through adapting its care representing the human part of the Mexican Navy. Keywords: Military, naval nursing, care.

Malaria in a returning traveler from Jamaica.

Malaria in Jamaica is a real, but uncommon entity and poses a health risk to our Department of Defense personnel, which should not be overlooked in returning travelers. Malaria in Jamaica was actually considered eradicated in the 1960s, but there has been a reemergence attributed to the combination of Haitian nationals as well as endemic Anopheles mosquitoes in the Kingston area. Our facility recently admitted a 33-year-old Marine who had two Emergency Department visits before being evaluated for malaria. He had returned from Kingston 14 days before presentation, which included fever, night sweats, and headache followed by a period of malaise prior to the next paroxysm. He was found to have a 1.5% parasitemia with Malaria falciparum that borders on severe malaria. Fortunately, he was treated effectively with atovaquone/proguanil and had a favorable outcome. The Center for Disease Control acknowledges that malaria is present in Jamaica, but only recommends mosquito avoidance without prophylaxis. This case emphasizes the need to consider malaria in differential diagnosis in Jamaica as well as in any returning travelers with fever because of broad global travel.

[From pirates to virus: the Oropesa's journey]. / De piratas a virus: La travesía del Oropesa.

In 1902, being Chile a country free of yellow fever, the British steamship Oropesa arrived from Rio de Janeiro with three passengers suffering this disease. Captain Hayes rejected the quarantine imposed by the local Junta of Sanity in Punta Arenas and also in Coronel, following his journey with the sick passengers to Valparaiso, port where he accepted a brief quarantine and medical services for the most compromised of the three patients, who unfortunately died. The knowledge about yellow fever and the applicable epidemiological measures in that time in Chile come to us through the sessions of the Superior Council of Public Hygiene. The threat that implicated the presence of the Oropesa in Chilean coasts is compared with the arrival of British pirates and corsairs in the colonial centuries, before the independence, announced with the alarm cry charque (for Sharp) is coming to Coquimbo!

Legal aspects of cruise medicine - can a non-US ship's doctor be sued for malpractice in Florida?

An English ship's doctor treated a non-US female patient for abdominal discomfort on a foreign-flagged cruise ship off the coast of Haiti. In Mexico the patient underwent abdominal surgery, followed by complications, for which her lawyers wanted to take the ship's doctor to court in Florida, USA. A trial court granted their wish, but this decision was reversed on appeal as the factors discussed were insufficient to establish Florida jurisdiction over the ship's doctor. The decision is not about whether malpractice occurred; it is about limiting the possibility of taking the ship's doctor to a court in a location preferred by the plaintiffs' lawyers. The appeal court ruling is important for non-US doctors working as independent contractors on cruise vessels that visit US ports, and it will hopefully prevent some of the more frivolous law suits from being filed in the future.

Reshaping US Navy Pacific response in mitigating disaster risk in South Pacific Island nations: adopting community-based disaster cycle management.

The US Department of Defense continues to deploy military assets for disaster relief and humanitarian actions around the world. These missions, carried out through geographically located Combatant Commands, represent an evolving role the US military is taking in health diplomacy, designed to enhance disaster preparedness and response capability. Oceania is a unique case, with most island nations experiencing "acute-on-chronic" environmental stresses defined by acute disaster events on top of the consequences of climate change. In all Pacific Island nation-states and territories, the symptoms of this process are seen in both short- and long-term health concerns and a deteriorating public health infrastructure. These factors tend to build on each other. To date, the US military's response to Oceania primarily has been to provide short-term humanitarian projects as part of Pacific Command humanitarian civic assistance missions, such as the annual Pacific Partnership, without necessarily improving local capacity or leaving behind relevant risk-reduction strategies. This report describes the assessment and implications on public health of large-scale humanitarian missions conducted by the US Navy in Oceania. Future opportunities will require the Department of Defense and its Combatant Commands to show meaningful strategies to implement ongoing, long-term, humanitarian activities that will build sustainable, host nation health system capacity and partnerships. This report recommends a community-centric approach that would better assist island nations in reducing disaster risk throughout the traditional disaster management cycle and defines a potential and crucial role of Department of Defense's assets and resources to be a more meaningful partner in disaster risk reduction and community capacity building.

Hunger strikers: ethical and legal dimensions of medical complicity in torture at Guantanamo Bay.

Physicians and other licensed health professionals are involved in force-feeding prisoners on hunger strike at the US Naval Base at Guantanamo Bay (GTMO), Cuba, the detention center established to hold individuals captured and suspected of being terrorists in the wake of September 11, 2001. The force-feeding of competent hunger strikers violates medical ethics and constitutes medical complicity in torture. Given the failure of civilian and military law to end the practice, the medical profession must exert policy and regulatory pressure to bring the policy and operations of the US Department of Defense into compliance with established ethical standards. Physicians, other health professionals, and organized medicine must appeal to civilian state oversight bodies and federal regulators of medical science to revoke the licenses of health professionals who have committed prisoner abuses at GTMO.

Nodular fasciitis: an uncommon disease with common medical management challenges at a remote Naval Hospital.

Nodular fasciitis is a rare benign soft tissue lesion that is often confused with malignant sarcoma, which can make management of this pathology challenging. We present here a case of head and neck nodular fasciitis that was managed at a remote U.S. Naval Hospital with limited diagnostic and therapeutic resources. The aim of this article is to bring to light this uncommon pathology so that it can be given its due consideration in the differential diagnosis from both a clinical and pathologic perspective. However, the more important purpose of this article is to highlight the complex decision-making process that sometimes occurs when evaluating patients within a medical infrastructure that is significantly less than that of a typical military treatment facility or U.S. hospital. Young surgeons and other providers may find this discussion useful before deploying, whether it be to a remote land-based facility or to an aircraft carrier.

Piracy on the high seas-threats to travelers' health.

BACKGROUND: Piracy has been threatening international sea trade and creating risk for crews and passengers worldwide. The problem is largely confined to the Somalia coast, West Africa, South America, and Southeast Asia. The targets are merchant ships, cruising yachts, and passenger ships with several thousand people on board. Such attacks can result in loss of lives, short- and long-term health problems, and can further be complicated by the consequences of hostage situations on shore. The purpose of this article is to present the problem of piracy, its relevance to the field of travel medicine, and help travel medicine practitioners to deal with its specifics before, during, and after attack. METHODS: Comprehensive literature research was done and published data from 2002 until 2012 from the International Chamber of Commerce specialized division-International Maritime Bureau (IMB)-on 3,806 attacks and 7,635 incidents involving human victims are analyzed. Available occupational health data in merchant marine and epidemiological data acquired on board cruise ships were used to estimate the health risks. RESULTS: From 2002 until 2012, 3,806 ships were attacked including 82 yachts and 13 passenger ships. A number of reported piracy attacks worldwide continued to threaten security and lives on sea. In 2012, 297 incidents of piracy and armed robbery were reported, a total of 585 crew members were taken hostage, 26 kidnapped, and 6 killed as a direct result of the incident.(1) CONCLUSION: The risk of being injured or killed by pirates on board cruise ships is actually very low. Piracy on the world's seas is in decline and remains a reasonably localized issue. While this improvement is a result of continued efforts of international naval forces, that protection is only partial and fails to suppress piracy completely. Piracy still presents significant threat to international travel, and future involvement of travel medicine practitioners in providing advice to travelers to piracy regions or victims of piracy is expected.

Professional skippers' sun-protection knowledge and behavior in the tropics.

A preliminary inquiry, conducted on Martinique Island, sought to determine professional skippers' sun-protection knowledge and behavior. Fifty-two skippers (mean age: 41 years) completed a questionnaire; 39 (75 %) had a simple sunburn over the last 6 months and 3 (6%) severe sunburn; 54 (64%) declared achieving sun protection by wearing clothes during >90% of the day. Only 17% had used sun protection >90% of the time.

The use of volunteer interpreters during the 201 0 Haiti earthquake: lessons learned from the USNS COMFORT Operation Unified Response Haiti.

On January 12, 2010, a 7.0 magnitude Richter earthquake devastated Haiti, leading to the world's largest humanitarian effort in 60 years. The catastrophe led to massive destruction of homes and buildings, the loss of more than 200,000 lives, and overwhelmed the host nation response and its public health infrastructure. Among the many responders, the United States Government acted immediately by sending assistance to Haiti including a naval hospital ship as a tertiary care medical center, the USNS COMFORT. To adequately respond to the acute needs of patients, healthcare professionals on the USNS COMFORT relied on Haitian Creole-speaking volunteers who were recruited by the American Red Cross (ARC). These volunteers complemented full-time Creole-speaking military staff on board. The ARC provided 78 volunteers who were each able to serve up to 4 weeks on board. Volunteers' demographics, such as age and gender, as well as linguistic skills, work background, and prior humanitarian assistance experience varied. Volunteer efforts were critical in assisting with informed consent for surgery, family reunification processes, explanation of diagnosis and treatment, comfort to patients and families in various stages of grieving and death, and helping healthcare professionals to understand the cultural context and sensitivities unique to Haiti. This article explores key lessons learned in the use of volunteer interpreters in earthquake disaster relief in Haiti and highlights the approaches that optimize volunteer services in such a setting, and which may be applicable in similar future events.

Three phases of disaster relief in Haiti--pediatric surgical care on board the United States Naval Ship Comfort.

BACKGROUND: On January 12, 2010, Haiti experienced the western hemisphere's worst-ever natural disaster. Within 24 hours, the United States Naval Ship Comfort received orders to respond, and a group of more than 500 physicians, nurses, and staff undertook the largest and most rapid triage and treatment since the inception of hospital ships. METHODS: These data represent pediatric surgical patients treated aboard the United States Naval Ship Comfort between January 19 and February 27, 2010. Prospective databases managed by patient administration, radiology, blood bank, laboratory services, and surgical services were combined to create an overall patient care database that was retrospectively reviewed for this analysis. RESULTS: Two hundred thirty-seven pediatric surgical patients were treated, representing 27% of the total patient population. These patients underwent a total of 213 operations composed of 243 unique procedures. Orthopedic procedures represented 71% of the total caseload. Patients returned to the operating room up to 11 times and required up to 28 days for completion of surgical management. CONCLUSIONS: This represents the largest cohort of pediatric surgical patients in an earthquake response. Our analysis provides a model for anticipating surgical caseload, injury patterns, and duration of surgical course in preparing for future disaster response missions. Moreover, we propose a 3-phased response to disaster medicine that has not been previously described.