Encyclopedia of Global Health (4 Vol. Set )

ENCYCLOPEDIA OF

Global health

ENCYCLOPEDIA OF

global health YAWEI ZHANG general editor

Copyright © 2008 by SAGE Publications, Inc. All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Readers are advised and encouraged to seek either a professional opinion or a medical diagnosis for any condition they may have. For information: SAGE Publications, Inc. 2455 Teller Road Thousand Oaks, California 91320 E-mail: order @ sagepub.com SAGE Publications Ltd. 1 Oliver’s Yard 55 City Road London EC1Y 1SP United Kingdom SAGE Publications India Pvt. Ltd. B 1/ I 1 Mohan Cooperative Industrial Area Mathura Road, New Delhi 110 044 India SAGE Publications Asia-Pacific Pte. Ltd. 33 Pekin Street #02-01 Far East Square Singapore 048763 Library of Congress Cataloging-in-Publication Data Encyclopedia of global health/Yawei Zhang, general editor. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4129-4186-0 (cloth : alk. paper) 1. World health—Encyclopedias. 2. Public health—Encyclopedias. 3. Medicine—Encyclopedias. I. Zhang, Yawei. [DNLM: 1. World Health—Encyclopedias—English. 2. Medicine—Encyclopedias—English. WA 13 E5566 2008] RA441.E53 2008 362.103—dc22

2007037954

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ENCYCLOPEDIA OF

Global health CoNteNtS

About the General Editor Introduction

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Reader’s Guide

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List of Articles

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List of Contributors Chronology

1–1777

Resource Guide Glossary Appendix Index

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Articles A to Z

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1779 1783 1841

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About the General Editor

Encyclopedia of Global Health About the General Editor

Yawei Zhang, M.D., Ph.D. Assistant Professor Yale University Division of Environmental Health Sciences Dr. Zhang received medical training at West China University of Medical Sciences between 1987 and 1993. After her graduation, she worked at Gansu Health Department, Lanzhou, China for about six years on several major public health studies, such as the National Children’s Nutrition Survey Study and the Children’s Immunization Program. These nationwide activities inspired her to further pursue research in the field of public health. In addition, her public health experience in China has also made her believe the importance of health education and the pursuit of research to advance the global understanding of the causes, treatment and prevention of disease. Dr. Yawei Zhang is currently an Assistant Professor at Yale University School of Public Health. Prior to her appointment at Yale, she obtained postdoctoral training at the National Cancer Institute. She received her Master’s degree and Ph.D. degree in Public Health at Yale University. As a cancer epidemiologist, Dr. Zhang has been conducting epidemiological studies of human cancer risk involving various cancers, including Hodgkin’s lymphoma and non-Hodgkin’s lymphoma, multiple myeloma, and cancers of the breast, testis, lung, and thyroid. During the past 10 years of research, she worked as Principal Investigator, CoInvestigator, Biostatistician, and Project Director for several major epidemiological studies investigating environmental exposures, endogenous hormones, genetic polymorphisms, and gene–environment interactions in the risk of human cancer. She is currently the Principal Investigator for epidemiological study of Quality of Life among Testicular Cancer Survivors. Dr. Zhang’s research has made a significant impact on cancer prevention and control as reflected in her scientific publications.

Introduction The contemporary understanding of global health is complicated and extends to all ends of the Earth and beyond. From the health effects of global warming to the implications of single nucleotide differences on disease, the factors that impact global health are extremely diverse and are changing constantly. As new scientific advances are made, as new policies are implemented, as wars are waged and peace agreements signed, or as new strains of infectious diseases evolve, the state of global health changes. Despite this dynamic and diverse system of knowledge, there are issues, people, discoveries, and advances that stand out as having made a significant impact on global health over the past centuries. This encyclopedia subsequently provides readers with a historical context for important changes and issues in global health and will serve as a foundation of knowledge. However, I invite you to use this information to inform your understanding of the current issues and challenges facing the field of global health and to participate in current global health discourse. The globalization of health began in the late fifteenth century when the European explorers discovered the Americas. Not only did the European explorers establish trade routes between Asia, Europe, and the Americas, they also geographically spread disease between continents. Soon after, they made connection between Africa and the Americas through slave trade, as well as many other areas of the world where

they traded. Over the past several decades, rapid development of economic, political, social, and cultural globalization and the easy access to high-speed forms of transportation have lead to an exponential rise in international travel. It has given rise to new patterns in the spread of infectious diseases. The recent outbreak of the virus SARS (Severe Acute Respiratory Syndrome) represents a good example of how new infectious diseases can spread globally in an unprecedented speed. Health officials in Hong Kong reported that within seven days, a man infected with SARS had flown from Hong Kong to Munich, Barcelona, Frankfurt, London, Munich again, Frankfurt again and then back to Hong Kong before entering a hospital. The man is believed to be responsible for spreading SARS to Europe. On the other hand, the international response to SARS highlights the importance of global scientific networks in addressing the problem of emergent infectious diseases. While it took two years to identify HIV as the cause of AIDs in 1980s, it took only two weeks to identify coronavirus as the cause of SARS in the recent outbreak because the World Health Organization (WHO) created a global network involving 13 laboratories in ten countries to work on the case of SARS. A number of new infectious diseases have emerged during the past several decades that can be attributed to the urbanization, deforestation, change in land use vii

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Introduction

and climate, population growth, poverty, political instability, and even terrorism. The rise of globalization has also lead to a rise in the incidence of non-communicable diseases through the adoption of unhealthy lifestyles, including stress, alienation and the aggressive marketing of fast foods, cigarettes, and alcohol. Although economic development and the introduction of modern medicine have reduced the incidence of infectious diseases and have made a general improvement in population health, the reduction of mortality from infectious diseases has been paralleled by an increase in non-communicable diseases, such as heart disease, diabetes, and cancer. This health transition experienced by most developing countries has been slower than the health transition in the more developed countries. Globalization has promoted uneven socioeconomic development in many developing countries, leading to rising incomes for certain sectors of the population and to lifestyle changes in these sectors that create a new health burden of noncommunicable diseases and injuries. Meanwhile the poorer sectors of the population whose incomes and lifestyles have not changes that much still suffer from the old health burden of infectious diseases and malnutrition. The Global Burden of Disease project by the World Bank and the WHO in the early 1990s provided evidence of the epidemiological transition of disease burden in developing countries, and predicted that causes of death attributable to non-communicable diseases are expected to rapidly increase while causes of death attributable to communicable, perinatal, maternal and nutritional causes will decline over the next couple of decades. The international health data in 1990 revealed that the heart disease, stroke, and cancer have replaced the major communicable diseases and malnutrition as the prime causes of death worldwide, and the total number of deaths from non-communicable disease causes was actually greater in the developing countries than in more-developed countries.

Infectious Diseases

Infectious diseases, also called communicable diseases, are characterized by the presence or activation of one or more pathogenic microbial agents, transmitted through contact with infected individuals, by water, food, airborne inhalation, or through vector-borne spread. Infectious diseases have historically been the leading cause of human morbidity and mortality. Over the past 150 years, the mortality due

to infectious diseases has declined substantially in developed countries, and non-communicable diseases such as cardiovascular disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes mellitus have become the leading causes of death in these countries. In the United States, only pneumonia, influenza, and HIV/AIDS, currently, rank among the top 10 causes of mortality. However, in developing countries, acute infectious diseases are the leading cause of death among children and young adults, and account for half of all deaths. It has been suggested that acute infectious diseases will decrease substantially during the next few decades. In addition, it is well documented that chronic infections plays an important role in pathogenesis of a number of chronic diseases, including cervical cancer (human papilloma virus [HPV]), hepatic cancer and cirrhosis (hepatitis B virus [HBV] and probably hepatitis C virus [HCV]), gastric cancer and peptic ulcer disease (Helicobacter pylori), and possible cardiovascular disease (Chlamydia pneumoniae or other infectious agents). A number of strategies have been employed to prevent morbidity and mortality from specific infectious diseases, including vector control (i.e., malaria, dengue, yellow fever, and onchocerciasis [river blindness]), vaccination (i.e., smallpox, measles, polio, neonatal tetanus, diphtheria, pertussis, tetanus, hepatitis B, meningococcal meningitis, and yellow fever), mass chemotherapy (i.e., hookworm, onchocerciasis, dracunculiasis [guinea worm], and sexually transmitted infections [STIs]), improved sanitation and access to clean water (i.e., diarrheal diseases), improved careseeking and caregiving (i.e., diarrheal diseases, acute respiratory infections, and neonatal tetanus), and behavior change (i.e., HIV and other STIs, diarrheal diseases, and dracunculiasis), among others. Through a combination of enhancements in case identification, containment, and vaccination, smallpox was successfully eradicated in the late 1970s worldwide. WHO and various partner agencies subsequently launched the Expanded Program of Immunizations (EPI) in 1974 to eradicate polio, dramatically reducing morbidity and mortality from measles and neonatal tetanus, and decreasing morbidity and mortality from diphtheria and pertussis worldwide. Furthermore, the success of HBV and HPV vaccination makes hepatic cancer and cirrhosis from HBV infection and cervical cancer from HPV a preventable chronic disease.



Non-communicable Diseases

Non-communicable diseases are also called chronic diseases, or degenerative diseases, which are characterized by complex risk factors, functional impairment or disability, with a prolonged course of illness and the unlikelihood of cure. While it has been a major public health concern in developed countries, non-communicable diseases are expected to become a big burden to developing countries during the next few decades. In 1990, epidemiologists found that non-communicable diseases such as heart disease, stroke, and cancer have replaced the major communicable diseases and malnutrition as the prime causes of death worldwide, and estimated that by 2020 non-communicable diseases will account for 7 of 10 deaths in developing countries. Considerable efforts have been made to investigate potential risk factors for non-communicable diseases since the 1950s. It is currently well accepted that tobacco use, alcohol consumption, dietary intake, and physical activity are the major principle lifestyle factors highly associated with non-communicable diseases morbidity and mortality. In addition, a number of other factors are also currently linked to the etiology of non-communicable diseases, including social class, culture, social networks, education, income, race, gender, and occupation, although the results from current available literatures are inconsistent. Cardiovascular disease refers to a group of diseases that involve heart and blood vessels. While it has been the leading cause of death and disability in industrialized countries, it is the second leading cause of death and disability among individuals in developing countries. In 2000, cardiovascular diseases accounted for 20 percent of all deaths worldwide. The mortality pattern varies by age, race, and gender. Not only is cardiovascular disease the major cause of death in older age groups and in men, it is also a very significant contributor to mortality in persons of economically productive ages (30–69 years) and in women. In the United States, cardiovascular disease mortality is higher in men than in women, and less for white men and women than for black men and women. Although cardiovascular disease has been widely studied in developed countries, information on diagnosis, treatment, and their natural history is sparse in developing countries. Cancer is the second leading cause of death in the United States. The global burden of cancer is currently unclear because of the limited information on

Introduction

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cancer incidence in developing countries. The International Agency for Research on Cancer (IARC) has produced numerous publications on cancer, including a detailed compilation of cancer incidence data from high-quality registries, which served as the basis for global estimation of cancer. The incidence rate of specific cancers varies between developed and developing countries. While cancers of the lung, breast, colon, and prostate are the most frequent types in the developed world, cancers of the mouth and oropharynx, stomach, and liver are the most common malignancies in the developing world. Although lung cancer is relatively less common in the developing countries, its incidence and mortality is increasing as tobacco smoking becomes more prevalent. One of the well-established risk factors for lung cancer is tobacco smoking, but it is the most difficult to control because tobacco products are a great source of revenue for businesses and a major source of tax revenue for many governments. It has been suggested that 81 percent of worldwide liver cancer is attributable to infectious with hepatitis B and C viruses and to parasites that invoke a chronic inflammatory process. Because these infectious agents are more prevalent in developing countries, liver cancer is more frequent in these countries. Hepatitis B is generally transmitted through sexual intercourse or mother to child. A vaccination against hepatitis B is available now and has been demonstrated to be effective in reducing the incidence of liver cancer. In developing countries, the state-of-the-art medical treatments with surgery or chemotherapeutic medicines are not widely available. As such, the major focus is on prevention rather than treatment. Although enormous resources are devoted to treating cancer in developed countries such as the United States, prevention efforts have also proven to be the most successful means of decreasing mortality from cancer over the past several decades. A recent publication by IARC demonstrated that differences in the average length of survival between developed and developing countries were greatest for certain cancers in which multiple therapy (radiation, surgery, and chemotherapy) is most effective, including testicular cancer, leukemia, and lymphoma that occur predominantly among younger individuals. However, for the most common preventable cancers such as those of the mouth, stomach, liver, and lung, uniformly poor survival outcomes in all registries including those in either developed or developing countries were observed.



Introduction

Diabetes has become enormously prevalent and is a major cause of disability worldwide. There are two major distinct types, (a) insulin-dependent diabetes mellitus or type 1 diabetes which is characterized by immune destruction of the cells of the pancreas that secrete insulin; and (b) noninsulin-dependent diabetes mellitus or type 2 diabetes which is characterized by a high level of serum glucose and elevated levels of insulin. Type 1 diabetes usually occurs in younger people and appears to have a strong genetic component. It has been shown that type 1 diabetes rates are the highest in Finland and Sweden and the lowest in Asian countries, Mexico, Chile, and Peru. In the United States, the disease rates are generally higher among the white population than black or Hispanic population, but the lowest among Native Americans. On the other hand, type 2 diabetes prevalence is increasing among populations experiencing modernization with decreases in physical activity and increases in average body mass. The high rates of type 2 diabetes have been observed in Pacific Islanders, Australian aborigines, Asian Indians, and certain subsets of Native Americans. Both types of diabetes can lead to major complications including blindness, renal failure, injuries and chronic infections of the extremities, or even large vessel disease, such as ischemic heart disease. As such, the WHO has identified diabetes as a major priority in non-communicable disease control. Injuries are among the leading causes of death and burden of diseases all over the world. Every day, almost 16,000 individuals die from injuries. Incidence and severity of injuries vary according to age, sex, race, occupation, as well as economic and geographic factors. Globally, injuries are an enormous toll for children, adolescents and young adults, and their associated death rates are higher among boys than among girls. The burden of injuries in developing countries differs from developed countries. China, Latin America, the Caribbean, sub-Saharan Africa are among the highest injury burden countries. Compared to intentional injuries, unintentional injuries conferred a much bigger health burden. Unintentional injuries are responsible for 5.2 percent of total deaths and account for 10–30 percent of all hospital admissions. The leading cause of injury deaths is motor-vehicle accidents globally, then suicide, homicide, drowning, war-related injuries, falls, burns, and poisonings. Although motor-vehicle injuries are preventable, declines in incidence have not been observed around the world. In fact, increases during the next few years are expected because a number of factors that con-

tribute to motor-vehicle injuries are still issues particularly in for developing countries, including rapid population growth, increasing motorization, little access to emergency care, lack of safety features in cars, crowded roads, poor road maintenance, and lack of police enforcement.

Mental Health

Mental health has received little attention historically because of its limited mortality. However, a recent assessment using the disability-adjusted life years (DALYs) as an indicator of the burden of disease has underscored the importance of mental health and stimulated reexamination of international health priorities. In developing countries, five of the ten leading causes of disability among persons 15–44 years are mental health and behavioral problems. All together, these five conditions account for almost 22 percent of all DALYs in the most productive years of life. While mental health and related conditions accounted for 10.5 percent of the disease burden with an additional 1.5 percent attributed to intentional injuries in developing countries, they accounted for 23.5 percent with an additional 2.2 percent attributed to intentional injuries in developed countries. It has been estimated that mental health and related conditions in developing countries are increasing toward the level in developed countries.

The Encyclopedia

The Encyclopedia of Global Health is a comprehensive A to Z, interdisciplinary, one-stop reference to a broad array of health topics worldwide. It covers all aspects of health including physical and mental health entries, current health status in each country of the five continents, biographies of major doctors and researchers, profiles of major medical institutes, organizations, corporations, and foundations, descriptions of major drugs and operations, articles on national health policies, and thematic health topics in the humanities. Pedagogical elements of the encyclopedia include an in-depth chronology detailing advances in health through history, a glossary of health definitions, extensive cross-references to related topics, and thorough bibliographic citations. Not only is the Encyclopedia of Global Health a useful reference for health professionals, but also for general populations. Yawei Zhang General Editor

Reader’s Guide This list is provided to assist readers in finding articles related by category or theme. CHILDREN’S HEALTH

Adolescent Development Adolescent Health Adoption Medicine Alcohol and Youth Asthma in Children Birth Defects Breech Birth Child Abuse Child Behavior Disorders Child Dental Health Child Development Child Mental Health Child Safety Childhood Cancers Childhood Immunization Diabetes Type I (Juvenile Diabetes) Dysmorphology Exercise for Children Failure to Thrive Fetal Alcohol Syndrome Hearing Problems in Children Infant and Newborn Care Infant and Toddler Development Infant and Toddler Health Juvenile Rheumatoid Arthritis Neonatologist Neonatology

Pediatrics Premature Babies Prenatal Care Rickets Smoking and Youth Spina Bifida Sudden Infant Death Syndrome Tanner Stages

COUNTRIES: AFRICA

Algeria Angola Benin Botswana Brunei Darussalam Burkina Faso Burundi Cameroon Cape Verde Central African Republic Chad Comoros Congo Congo, Democratic Republic Côte d’Ivoire Djibouti Egypt Equatorial Guinea

Eritrea Ethiopia Gabon Gambia Ghana Guinea Guinea-Bissau Kenya Lesotho Liberia Madagascar Malawi Mali Mauritania Mauritius Morocco Mozambique Namibia Niger Nigeria Rwanda São Tomé and Principe Senegal Sierra Leone Somalia South Africa Sudan Swaziland

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Tanzania Togo Tunisia Uganda Zambia Zimbabwe

Antigua and Barbuda Argentina Bahamas Barbados Belize Bolivia Brazil Canada Chile Colombia Costa Rica Cuba Dominica Dominican Republic Ecuador El Salvador Grenada Guatemala Guyana Haiti Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago United States Statistics Uruguay Venezuela

China East Timor Georgia India Indonesia Iran Iraq Israel Japan Jordan Kazakhstan Korea, North Korea, South Kuwait Kyrgyzstan Laos Lebanon Malaysia Maldives Moldova Mongolia Myanmar Nepal Oman Pakistan Palestine Philippines Qatar Russia Saudi Arabia Seychelles Singapore Sri Lanka Syria Tajikistan Thailand Turkey Turkmenistan Ukraine United Arab Emirates Uzbekistan Vietnam Yemen

COUNTRIES: ASIA

COUNTRIES: EUROPE

COUNTRIES: AMERICAS

Afghanistan Azerbaijan Bahrain Bangladesh Bhutan Cambodia

Albania Andorra Armenia Austria Belarus Belgium

Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Liechtenstein Lithuania Luxembourg Macedonia FYROM Malta Monaco Netherlands Norway Poland Portugal Romania San Marino Serbia and Montenegro Slovakia Slovenia Spain Sweden Switzerland United Kingdom

COUNTRIES: PACIFIC Australia Fiji Kiribati Marshall Islands Micronesia Nauru New Zealand Palau Papua New Guinea Samoa Solomon Islands Tonga Tuvalu Vanuatu

Reader’s Guide



DISEASES, CANCERS

Adrenocortical Carcinoma Anal Cancer Bile Duct Cancer Bladder Cancer Bone Cancer Brain Cancer Breast Cancer Cancer (General) Carcinoid Tumors Carcinoma of Unknown Primary Colorectal Cancer Esophageal Cancer Extragonadal Germ Cell Tumor Eye Cancer Gallbladder Cancer Head and Neck Cancer Hodgkin’s Lymphoma Kidney Cancer Leukemia Liver Cancer Lung Cancer Malignant Mesothelioma Multiple Myeloma Neuroblastoma Non-Hodgkin Lymphoma Oncologist Oncology Oral Cancer Osteonecrosis Ovarian Cancer Pancreatic Cancer Penile Cancer Pheochromocytoma Pituitary Tumor Prostate Cancer Skin Cancer Small Intestine Cancer Soft Tissue Sarcoma Stomach Cancer Testicular Cancer Thymus Cancer Thyroid Cancer Uterine Cancer Vaginal Cancer Vulvar Cancer

DISEASES, LOCALIZED Acid Reflux Acne Acoustic Neuroma

Age-Related Macular Degeneration Alzheimer’s Disease Amblyopia Anal/Rectal Diseases Aneurysms Angina Aphasia Appendicitis Arrhythmia Arteriosclerosis Asbestos/Asbestosis Asthma Back Injuries Back Pain Bell’s Palsy Birthmark Bladder Diseases Blepharitis Blepharospasm Blindness Bone Diseases Bone Marrow Diseases Brain Diseases Brain Injuries Brain Malformations Breast Diseases Breathing Problems Bronchitis Carpal Tunnel Syndrome Cataract Celiac Disease Cellulitis Chlamydia Infections Chronic Obstructive Pulmonary Disease (COPD) Cirrhosis Cleft Lip and Palate Colon Polyps Colonic Diseases (General) Concussion Congenital Heart Disease Conjunctivitis Connective Tissue Disorders Constipation Cornea and Corneal Disease Coronary Disease Deafness Dental Health Dermatitis Diabetic Eye Problems Diabetic Foot

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Diabetic Kidney Problems Diabetic Nerve Problems Diabetic Teeth and Gum Problems Diarrhea Digestive Diseases (General) Diverticulosis and Diverticulitis Dysphagia Ear Disorders Ear Infections Elbow Injuries and Disorders Emphysema Esophagus Disorders Eye Diseases (General) Facial Injuries and Disorders Foot Health Foot Injuries and Disorders Fractures Gallbladder and Bile Duct Diseases Gastroesophageal Reflux/Hiatal Hernia Gastrointestinal Bleeding Genetic Brain Disorders Genital Herpes Glaucoma Glomerular Diseases Goiter Gonorrhea Gout and Pseudogout Gum Disease Hair Diseases and Hair Loss Hand Injuries and Disorders Head and Brain Injuries Head and Brain Malformations Head Lice Headache and Migraine Heart Attack Heart Diseases (General) Heart Valve Diseases Hemorrhoids Hepatitis Hepatitis C Hernia Hip Injuries and Disorders Huntington’s Disease Hydrocephalus Impetigo Incontinence Inflammatory Bowel Disease Intestinal Parasites Irritable Bowel Syndrome Kidney Diseases (General) Kidney Failure and Dialysis

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Kidney Stones Knee Injuries and Disorders Leg Injuries and Disorders Liver Diseases (General) Low Vision Meniere’s Disease Mouth Disorders Neck Disorders and Injuries Neural Tube Defects Nose Disorders Onchocerciasis Paget’s Disease of Bone Pancreatic Diseases Peptic Ulcer Pneumonia Polycystic Kidney Disease Pulmonary Embolism Pulmonary Fibrosis Raynaud’s Disease Respiratory Diseases (General) Retinal Disorders Rheumatic Heart Disease Rosacea Salivary Gland Disorders Scoliosis Severe Acute Respiratory Syndrome (SARS) Shoulder Injuries and Disorders Sinusitis Skin Diseases (General) Skin Pigmentation Disorders Spinal Cord Diseases Spinal Cord Injuries Spinal Muscular Atrophy Spinal Stenosis Spleen Diseases Stomach Disorders Taste and Smell Disorders Temporomandibular Joint Dysfunction Thoracic Outlet Syndrome Throat Disorders Thyroid Diseases Tinnitus Trachoma Tuberculosis Ulcers Urinary Tract Infections Usher Syndrome Vitiligo Voice Disorders Wrist/Arm Injuries and Disorders

DISEASES, SYSTEMIC

Acquired Mutation Addison’s Disease AIDS AIDS and Infections AIDS-Related Malignancies Alcoholism Allergy Anemia Anorexia Nervosa Arthritis Autoimmune Diseases (General) Bacterial Infections Beriberi Bird Flu Bleeding Disorders Botulism Bulimia Bursitis Cerebral Palsy Chagas Disease Chickenpox Cholera Chronic Fatigue Syndrome Coma Common Cold Cystic Fibrosis Degenerative Nerve Diseases Dengue Developmental Disabilities Diabetes Diabetes Type II Diphtheria Disabilities (General) Dizziness and Vertigo Down Syndrome Dystonia Eating Disorders E. Coli Infections Edema Ehlers-Danlos Syndrome Endocrine Diseases (General) Epilepsy Fainting Fever Filariasis / Elephantiasis Food Allergy Foodborne Diseases Fungal Infections Gaucher’s Disease Genetic Disorders

Germline Mutation Giardia Infections Growth Disorders Guillain-Barre Syndrome Hemorrhagic Fever Herpes Simplex High Blood Pressure Hyperactivity Hypoglycemia Hypothermia Immune System and Disorders Infectious Diseases (General) Influenza Klinefelter’s Syndrome Kwarshiorkor Lactose Intolerance Lead Poisoning Legionnaire’s Disease Leishmaniasis Leprosy Leukodystrophies Lou Gehrig’s Disease Low Blood Pressure Lupus Lyme Disease Lymphatic Diseases Malaria Marasmus Marfan Syndrome Measles Meningitis Metabolic Disorders Missense Mutation Movement Disorders Multiple Chemical Sensitivity Multiple Sclerosis Mumps Muscle Disorders Muscular Dystrophy Myasthenia Gravis Myositis Nausea and Vomiting Neurofibromatosis Neurologic Diseases (General) Neuromuscular Disorders Nonsense Mutation Osteoarthritis Osteogenesis Imperfecta Pain Paralysis Parasitic Diseases

Reader’s Guide



Parathyroid Disorders Parkinson’s Disease Peripheral Nerve Disorders Phenylketonuria Pituitary Disorders Point Mutation Poisoning Polio and Post-Polio Syndrome Polymyalgia Rheumatica Porphyria Prader-Willi Syndrome Psoriasis Rabies Reflex Sympathetic Dystrophy Rett Syndrome Reye Syndrome Rheumatoid Arthritis Rubella Salmonella Infections Sarcoidosis Scleroderma Seizures Sexually Transmitted Diseases Shingles (Herpes Zoster) Shistosomiasis Sickle Cell Anemia Sjogren’s Syndrome Smallpox Somatic Mutation Staphylococcal Infections Streptococcal Infections Stress Stroke Tay-Sachs Disease Tetanus Tourette Syndrome Transient Ischemic Attack Tremor Tuberous Sclerosis Turner’s Syndrome Typhoid Vasculitis Viral Infections Whooping Cough Wilson’s Disease

DRUGS AND DRUG COMPANIES Adult Immunization Amphetamines Anabolic Steroids Antibiotics

Drug and Medical Device Safety Generic Drug Immunization/Vaccination Inhalants Maintenance Medication Me-Too Drug Over-the-Counter (OTC) Drug Pharmaceutical Industry (Worldwide) Pharmacist Pharmaco-epidemiology Pharmacogenetics Pharmacogenomics Pharmacologist Pharmacology Pharmacopeia/Pharmacopoeia Pharmacy Placebo Prescription Drugs Abuse United States Pharmacopeia and National Formulary (USP-NF)

HEALTH SCIENCES

Acquired Immunity Active Immunity Activities of Daily Living (ADLs) Aerospace Medicine African American Health AIDS, Living with Air Pollution Alcohol Consumption Allele Allopathy Alpha Error Alternative Medicine Alzheimer’s Caregivers Amputees Anthrax Antioxidants Artificial Limbs Asian American Health Background Radiation Bacteriology Base Excision Repair Base Pair Base Sequence Beta Error Biochemistry Biodefense Bioinformatics Biological and Chemical Weapons Biomarker

Biosafety Bioterrorism Birth Cohort Birth Rate Bisexual Body Cell Mass Body Mass Index Body Surface Area Bone Health Bone Mass Density Bone Mineral Density Brown Fat Burns Caffeine Calcium Cancer—Coping with Cancer Cardiologist Cardiology Caregivers Carotenoid Cascade Centenarian Cervical Spine Chemokine Chemokinesis Chinese Medicine, Traditional Cholesterol Chromosome Chronology of Global Health Circadian Clone Club Drugs Cocaine Abuse Coefficient of Inbreeding Complex Humanitarian Emergencies Conventional Medicine Cosmetics Craniology Crossing Over Crude Mortality Rate Cytogenetics Cytokine Daily Reference Values (DRVs) Date Rape Death and Dying Death Rate Demographic Transition Diesel Exhaust Dieting Disasters and Emergency Preparedness Disease and Poverty

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Disease Prevention Dizygotic Twin DNA DNA Repair Drinking Water Drug Abuse Dyslexia Ecogenetics Ectoparasites Elder Abuse Electromagnetic Fields Electrophysiology Empiric Risk Endemic Endocrinology Engram Environmental Health Environmental Medicine Environmental Tobacco Smoke (ETS) Environmental Toxicology Epidemic Epidemiologist Epidemiology Epigenetics Evidence-Based Medicine Exercise for Seniors Exercise/Physical Fitness Eye Care Falls False Negative False Positive First American Medical School Flea Bites Fluoride Folic Acid Food Contamination/Poisoning Food Safety Forensic Medicine Fraternal Twins Gastroenterologist Gastroenterology Gay Gene Gene Pool Genetic Code Genetics Genomic Library Genotype Geriatrics Gerontology Global Health Ethics Hair Dye

Haploid Hardy-Weinberg Law Healthcare, Africa Healthcare, Asia and Oceania Healthcare, Europe Healthcare, South America Healthcare, U.S. and Canada Heart Diseases—Prevention Heat Index Hematologist Hematology Hemizygous Hemochromatosis Herbal Medicine Herbal Remedy Herbalism Herbalist Heroin Abuse Heterosexual Heterozygote Hispanic American Health Histology Homeopathy Homicide Homosexual Homozygote Hormones Household Poisons Hygiene Immunologist Immunology In Situ In Vitro In Vivo Inbreeding Incidence Indoor Air Pollution Infertility Innate Immunity Inpatient Institutional Review Board (IRB) Internal Medicine Internist Iridology Knockout Lean Body Mass Learning Disorders Lesbian Linkage Analysis Linkage Map Locus

Malariologist Malariology Marijuana Abuse Medical College Admissions Test (MCAT) Medical Entomology Medical Geography Medical Helminthology Medical Jurisprudence Medical Physics Medical Prefix Medical Tourism Memory Mercury Meta-analysis Methamphetamine Abuse Methylation Mismatch Repair Molds Monozygotic Twin Mortality Mosquito Bites Native American Health Naturopathy Nephrologist Nephrology Neuroendocrinology Neurologist Neurology Neuropsychologist Neuroradiologist Neuroradiology Neuroscience Neuroscientist Noise Nuclear Medicine Nutrition Nutritionist Obesity Occupational Health Occupational Injuries Occupational Medicine Ophthalmologist Ophthalmology Optometrist Oral Surgeon Organ Donation Orthomolecular Medicine Orthopedics Orthopedist Osteopathy Otolaryngologist

Reader’s Guide



Otolaryngology Otology Outpatient Ozone Passive Immunity Pasteurization Pathologist Pathology Pathophysiology Perinatologist Perinatology Pesticides Phenotype Phrenology Phylogenetics Physiatrist Physical Therapist Physiology Piercing and Tattoos Podiatrist Pollution Polymerase Chain Reaction (PCR) Polymorphism Prevalence Preventive Care Primary Care Proctology Programmed Cell Death Pulmonology Radiation Exposure Radiologist Radiology Radon Rare Diseases Refractive Errors Refugee Health Rehabilitation Reproductive Health (General) Roentgenology Safety (General) Satellite DNA Saturated Fat Sleep Disorders Smokeless Tobacco Smoking Smoking Cessation Snellen’s Chart Speech & Communication Disorders Spider Bites Sports Injuries Sprains and Strains

Sun Exposure Sun Protection Factor (SPF) Telepathology Third World Tick Bites Toxicology Trans Fat Travel Medicine Traveler’s Health Tropical Medicine Tumor Registry Ultraviolet Radiation United States Medical Licensing Examination (USMLE) United States Statistics Universal Donor Unsaturated Fat Urological Surgeon Urologist Virology Vitamin A Deficiency Vitamin and Mineral Supplements West Nile Virus

MEN’S HEALTH

AIDS Bisexual Breast Cancer Heterosexual Homosexual Hormones Impotence Infertility Male Genital Disorders Penile Cancer Prostate Cancer Prostate Diseases Reproductive Health (General) Testicular Cancer Urinary Tract Infections

MENTAL HEALTH

Anxiety Disorders Attention Deficit Disorder Attention Deficit Disorder with Hyperactivity Autism Bereavement Dementia Depression

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Manic-Depressive Illness Mental Health Obsessive-Compulsive Disorder Psychiatrist Psychiatry Psychoimmunology Psychologist Psychology Psychoneuroimmunology Psychooncology Psychotherapy Schizophrenia Suicide

ORGANIZATIONS AND ASSOCIATIONS

Adult Congenital Heart Association (ACHA) Alzheimer’s Association Alzheimer’s Disease Education and Referral Center (ADEAR) American Academy of Addiction Psychiatry (AAAP) American Academy of Family Physicians (AAFP) American Academy of Nurse Practitioners (AANP) American Academy of Ophthalmology (AAO) American Academy of Orthopedic Surgeons (AAOS) American Academy of Pediatrics (AAP) American Association for Cancer Research (AACR) American Association for Health Education (AAHE) American Association of Orthodontists (AAO) American Cancer Society (ACS) American College Health Association (ACHA) American College of Epidemiology (ACE) American College of Nurse-Midwives (ACNM) American College of Obstetricians and Gynecologists (ACOG) American College of Occupational and Environmental Medicine (ACOEM) American College of Physicians (ACP) American College of Preventive Medicine (ACPM)

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Reader’s Guide

American College of Sports Medicine (ACSM) American College of Surgeons (ACS) American Council for Fitness and Nutrition (ACFN) American Dental Association (ADA) American Dental Hygienists’ Association (ADHA) American Diabetes Association (ADA) American Fertility Association (AFA) American Geriatrics Society (AGS) American Health Care Association (AHCA) American Heart Association (AHA) American Lung Association American Medical Association (AMA) American Medical Women’s Association (AMWA) American Nurses Association (ANA) American Obesity Association (AOA) American Osteopathic Association American Pharmaceutical Association (APhA) American Podiatric Medical Association (APMA) American Pregnancy Association (APA) American Psychological Association (APA) American Public Health Association (APHA) American Red Cross American Social Health Association (ASHA) American Society for Reproductive Medicine (ASRM) American Society of Clinical Oncology (ASCO) American Society of Clinical Pathologists (ASCP) American Society of Human Genetics (ASHG) American Society on Aging (ASA) American Urological Association (AUA) Association for International Cancer Research (AICR) Association of Maternal and Child Health Programs (AMCHP) Association of Schools of Public Health (ASPH) Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)

European Association for Cancer Research (EACR) European Association for the Study of Obesity (EASO) Fondation Jean Dausset (CEPH) Human Genome Organisation (HUGO) Institute for Children’s Environmental Health (ICEH) Institute of Medicine (IOM) International AIDS Vaccine Initiative (IAVI) International Center for Equal Healthcare Access (ICEHA) International Classification of Diseases (ICD) International Clinical Epidemiology Network (INCLEN) International Committee of the Red Cross (ICRC) International Council of AIDS Service Organizations (ICASO) International Epidemiological Association (IEA) International Federation of Red Cross and Red Crescent Societies (IFRC) International Genetic Epidemiology Society (IGES) International Red Cross and Red Crescent Movement (RCRC) International Society for Environmental Epidemiology (ISEE) International Society for Pharmacoepidemiology (ISPE) International Society of Geographical and Epidemiological Ophthalmology (ISGEO) International Women’s Health Coalition (IWHC) MedicAlert Médicins Sans Frontières National Asian Women’s Health Organization (NAWHO) National Association of Health Data Organizations (NAHDO) National Association of People with AIDS (NAPWA) National Breast Cancer Coalition (NBCC) National Coalition for Cancer Survivorship (NCCS) National Environmental Health Association (NEHA)

National Mental Health Association (NMHA) National Network for Immunization Information (NNii) National Women’s Health Organization (NWHO) North American Association for the Study of Obesity (NAASO) Pasteur Institute School Nutrition Association (SNA) Society for Healthcare Epidemiology of America (SHEA) Society for Nutrition Education (SNE) Society for Public Health Education (SOPHE) Voluntary Euthanasia Society (VES)

PEOPLE

Abse, Dannie Ames, Bruce N. Avery, Oswald Theodore Axelrod, Julius Beals, Rodney K. Beijerinck, Martinus W. Bell, Charles Blackwell, Elizabeth Bross, Irwin D.J. Brown, Louise Brown, Michael Stuart Calabresi, Paul Casals-Ariet, Jordi Chekhov, Anton Chen, Zhong Wei Crick, Francis Da Vinci, Leonardo Darwin, Charles Ehrlich, Paul Farmer, Paul Fredrickson, Donald Gage, Phineas Galton, Sir Francis Gibbon, John H., Jr. Hardy, James D. Hounsfield, Godfrey Hughlings Jackson, John Kelman, Charles D. Kirklin, John W. Kübler-Ross, Elisabeth La Montagne, John Lauterbur, Paul C. Lederberg, Joshua

Reader’s Guide



Lewis, Edward B. Mansfield, Peter Marx, Gertie F. McClintock, Barbara Mead, Margaret Moscati, St. Joseph Nirenberg, Marshall W. Osler, Sir William Parkinson, James Pasteur, Louis Pauling, Linus Ramsay Hunt, James Rodbell, Martin Roentgen, Wilhelm Sabin, Albert Sabin, Florence R. Sachs, Jeffrey Schweitzer, Albert Soper, Fred L. Stewart, Alice Stickler, Gunnar B. Thomas, Lewis Thorn, George W. Varco, Richard L. Warshaw, Joseph Watson, James Wilkins, Lawson Zoll, Paul M.

PROCEDURES AND THERAPIES Acupuncture Allograft Angioplasty Biofeedback Biotherapy Blood/Blood Transfusion Cancer Alternative Therapy Cancer Chemotherapy Cancer Radiation Therapy Cardioversion Chemoprevention Chemoradiotherapy Chemotherapy Chiropractic Cryopreservation Cryosurgery Diagnostic Imaging Diagnostic Tests Dialysis Enzyme-Linked Immunosorbent Assay (ELISA)

Exercise Treadmill Test Gamete Intrafallopian Transfer (GIFT) Gel Electrophoresis Gene Array Analysis Gene Mapping Gene Silencing Gene Transfer Genes and Gene Therapy Genetic Testing/Counseling Genetic Transformation Genomic Imprinting Heart Bypass Surgery Heart Transplantation Immunosuppression Immunotherapy Kidney Transplantation Laboratory Tests Liver Transplantation Lung Transplantation Microsurgery Oral Rehydration Therapy Organ Transplantation Pancreas Transplantation Stem Cells/Stem Cell Transplantation Surgery Telesurgery

RESEARCH

Case-Control Study Clinical Trial Cohort Study Cross-Sectional Study Crossover Study Double-Blinded Study Framingham Heart Study Longitudinal Study Nurses’ Health Study Prospective Study Randomized Clinical Trial Retrospective Study SEER (Surveillance, Epidemiology, and End Results Program)

SOCIETY AND HEALTH

Administration on Aging (AoA) Administration for Children and Families (ACF) Agency for Healthcare Research and Quality (AHRD) Agency for Toxic Substances and Disease Registry (ATSDR)

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Center for Food Safety and Applied Nutrition (CFSAN) Centers for Disease Control and Prevention (CDC) Centers for Medicare and Medicaid Services (CMS) Department of Energy (DOE) Department of Health and Human Services (HHS) Drug Enforcement Administration (DEA) Employment Retirement Income Security Act (ERISA) Environmental Protection Agency (EPA) European Food Safety Authority (EFSA) European Public Health Alliance (EPHA) European Public Health Association (EUPHA) Federal Emergency Management Agency (FEMA) Fee-for-Service Food and Drug Administration (FDA) Food and Agriculture Organization of the United Nations (FAO) Global Health Council Health Insurance Portability and Accountability Act (HIPAA) Health Maintenance Organization (HMO) Health Resources and Services Administration (HRSA) Indian Health Service (IHS) Insurance International Agency for Research on Cancer (IARC) International Health Ministries Office (IHMO) Joint FAO/WHO Expert Committee on Food Additives (JECFA) Joint United Nations Programme in HIV/ AIDS (UNAIDS) Managed Care Medical Research Council Medicaid Medicare Medigap Policy MEDLINE Mine Safety and Health Administration (MSHA) National Cancer Institute (NCI) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)

xx

Reader’s Guide

National Center for Complementary and Alternative Medicine (NCCAM) National Center for Environmental Health (NCEH) National Center for Health Marketing (NCHM) National Center for Health Statistics (NCHS) National Center for HIV, STD, and TB Prevention (NCHSTP) National Center for Infectious Diseases (NCID) National Center for Injury Prevention and Control (NCIPC) National Center for Public Health Informatics (NCPHI) National Center on Birth Defects and Developmental Disabilities (NCBDDD) National Cholesterol Education Program (NCEP) National Eye Institute (NEI) National Heart, Lung, and Blood Institute (NHLBI) National Human Genome Research Institute (NHGRI) National Immunization Program (NIP) National Institute of Allergy and Infectious Diseases (NIAID) National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) National Institute of Biomedical Imaging and Bioengineering (NIBIB) National Institute of Children’s Health (NICHD) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) National Institute of Environmental Health Sciences (NIEHS)

National Institute of Mental Health (NIMH) National Institute of Neurological Disorders and Stroke (NINDS) National Institute of Nursing Research (NINR) National Institute of Occupational Safety and Health (NIOSH) National Institute on Aging (NIA) National Institute on Alcohol Abuse and Alcoholism (NIAAA) National Institute on Deafness and Other Communication Disorders (NIDCD) National Institute on Drug Abuse (NIDA) National Institutes of Health (NIH) National Library of Medicine (NLM) National Program of Cancer Registries (NPCR) Occupational Safety and Health Administration (OSHA) Pan American Health Organization (PAHO) Point of Service (POS) Preferred Provider Organization (PPO) Public Health Substance Abuse and Mental Health Services Administration (SAMHSA) United Nations Children’s Fund (UNICEF) United Network for Organ Sharing (UNOS) United States Public Health Service World Health Organization (WHO)

WOMEN’S HEALTH

Abortion AIDS AIDS and Pregnancy Birth Control/Contraception Bisexual Breast Cancer

Breast Feeding Breast Implants/Breast Reconstruction Cervical Cancer Climacteric Diabetes and Pregnancy Doula Estrogen Replacement Therapy (ERT) Female Circumcision Gynecologist Gynecology Heterosexual High Risk Pregnancy Hormone Replacement Therapy Hormones Infertility Lesbian Menopause Menstruation and Premenstrual Syndrome Midwife Obstetric Fistula Obstetrician/Gynecologist Obstetrics Osteoporosis Ovarian Cancer Postpartum Depression Preeclampsia Pregnancy Pregnancy and Substance Abuse Pregnancy Loss Reproductive Health (General) Smoking and Pregnancy Teenage Pregnancy Urinary Tract Infections Uterine Cancer Uterine Diseases Vaginal Cancer Vaginal Diseases Vulvar Cancer Women’s Health (General)

List of Articles A

Abortion Abse, Dannie Acid Reflux Acne Acoustic Neuroma Acquired Immunity Acquired Mutation Active Immunity Activities of Daily Living (ADLs) Acupuncture Addison’s Disease Administration for Children and Families (ACF) Administration on Aging (AoA) Adolescent Development Adolescent Health Adoption Medicine Adrenocortical Carcinoma Adult Congenital Heart Association (ACHA) Adult Immunization Aerospace Medicine Afghanistan African American Health Age-Related Macular Degeneration Agency for Healthcare Research and Quality (AHRD)

Agency for Toxic Substances and Disease Registry (ATSDR) AIDS AIDS and Infections AIDS and Pregnancy AIDS, Living with AIDS-Related Malignancies Air Pollution Albania Alcohol and Youth Alcohol Consumption Alcoholism Algeria Allele Allergy Allograft Allopathy Alpha Error Alternative Medicine Alzheimer’s Association Alzheimer’s Caregivers Alzheimer’s Disease Alzheimer’s Disease Education and Referral Center (ADEAR) Amblyopia American Academy of Addiction Psychiatry (AAAP) American Academy of Family Physicians (AAFP)

American Academy of Nurse Practitioners (AANP) American Academy of Ophthalmology (AAO) American Academy of Orthopedic Surgeons (AAOS) American Academy of Pediatrics (AAP) American Association for Cancer Research (AACR) American Association for Health Education (AAHE) American Association of Orthodontists (AAO) American Cancer Society (ACS) American College Health Association (ACHA) American College of Epidemiology (ACE) American College of Nurse-Midwives (ACNM) American College of Obstetricians and Gynecologists (ACOG) American College of Occupational and Environmental Medicine (ACOEM) American College of Physicians (ACP) American College of Preventive Medicine (ACPM) American College of Sports Medicine (ACSM) American College of Surgeons (ACS)

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List of Articles

American Council for Fitness and Nutrition (ACFN) American Dental Association (ADA) American Dental Hygienists’ Association (ADHA) American Diabetes Association (ADA) American Fertility Association (AFA) American Geriatrics Society (AGS) American Health Care Association (AHCA) American Heart Association (AHA) American Lung Association American Medical Association (AMA) American Medical Women’s Association (AMWA) American Nurses Association (ANA) American Obesity Association (AOA) American Osteopathic Association American Pharmaceutical Association (APhA) American Podiatric Medical Association (APMA) American Pregnancy Association (APA) American Psychological Association (APA) American Public Health Association (APHA) American Red Cross American Social Health Association (ASHA) American Society for Reproductive Medicine (ASRM) American Society of Clinical Oncology (ASCO) American Society of Clinical Pathologists (ASCP) American Society of Human Genetics (ASHG) American Society on Aging (ASA) American Urological Association (AUA) Ames, Bruce N. Amphetamines Amputees Anabolic Steroids Anal Cancer Anal/Rectal Diseases Andorra Anemia Aneurysms Angina Angioplasty

Angola Anorexia Nervosa Anthrax Antibiotics Antigua and Barbuda Antioxidants Anxiety Disorders Aphasia Appendicitis Argentina Armenia Arrhythmia Arteriosclerosis Arthritis Artificial Limbs Asbestos/Asbestosis Asian American Health Association for International Cancer Research (AICR) Association of Maternal and Child Health Programs (AMCHP) Association of Schools of Public Health (ASPH) Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) Asthma Asthma in Children Attention Deficit Disorder Attention Deficit Disorder with Hyperactivity Australia Austria Autism Autoimmune Diseases (General) Avery, Oswald Theodore Axelrod, Julius Azerbaijan

B

Background Radiation Back Injuries Back Pain Bacterial Infections Bacteriology Bahamas Bahrain Bangladesh Barbados Base Excision Repair Base Pair Base Sequence

Beals, Rodney K. Beijerinck, Martinus W. Belarus Belgium Belize Bell, Charles Bell’s Palsy Benin Bereavement Beriberi Beta Error Bhutan Bile Duct Cancer Biochemistry Biodefense Biofeedback Bioinformatics Biological and Chemical Weapons Biomarker Biosafety Bioterrorism Biotherapy Bird Flu Birth Cohort Birth Control/Contraception Birth Defects Birth Rate Birthmark Bisexual Blackwell, Elizabeth Bladder Cancer Bladder Diseases Bleeding Disorders Blepharitis Blepharospasm Blindness Blood/Blood Transfusion Body Cell Mass Body Mass Index Body Surface Area Bolivia Bone Cancer Bone Diseases Bone Health Bone Marrow Diseases Bone Mass Density Bone Mineral Density Bosnia and Herzegovina Botswana Botulism

List of Articles



Bovine Spongiform Encephalopathy Brain Cancer Brain Diseases Brain Injuries Brain Malformations Brazil Breast Cancer Breast Diseases Breast Feeding Breast Implants/Breast Reconstruction Breathing Problems Breech Birth Bronchitis Bross, Irwin D.J. Brown, Louise Brown, Michael Stuart Brown Fat Brunei Bulgaria Bulimia Burkina Faso Burns Bursitis Burundi

C

Caffeine Calabresi, Paul Calcium Cambodia Cameroon Canada Cancer (General) Cancer Alternative Therapy Cancer Chemotherapy Cancer Radiation Therapy Cancer—Coping with Cancer Cape Verde Carcinoid Tumors Carcinoma of Unknown Primary Cardiologist Cardiology Cardioversion Caregivers Carotenoid Carpal Tunnel Syndrome Casals-Ariet, Jordi Cascade Case-Control Study Cataract Celiac Disease

Cellulitis Centenarian Center for Food Safety and Applied Nutrition (CFSAN) Centers for Disease Control and Prevention (CDC) Centers for Medicare and Medicaid Services (CMS) Central African Republic Cerebral Palsy Cervical Cancer Cervical Spine Chad Chagas Disease Chekhov, Anton Chemokine Chemokinesis Chemoprevention Chemoradiotherapy Chemotherapy Chen, Zhong Wei Chickenpox Child Abuse Child Behavior Disorders Child Dental Health Child Development Child Mental Health Child Safety Childhood Cancers Childhood Immunization Chile China Chinese Medicine, Traditional Chiropractic Chlamydia Infections Cholera Cholesterol Chromosome Chronic Fatigue Syndrome Chronic Obstructive Pulmonary Disease (COPD) Chronology of Global Health Circadian Cirrhosis Cleft Lip and Palate Climacteric Clinical Trial Clone Club Drugs Cocaine Abuse Coefficient of Inbreeding

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Cohort Study Colombia Colonic Diseases (General) Colon Polyps Colorectal Cancer Coma Common Cold Comoros Complex Humanitarian Emergencies Concussion Congenital Heart Disease Congo Congo, Democratic Republic Conjunctivitis Connective Tissue Disorders Constipation Conventional Medicine Cornea and Corneal Disease Coronary Disease Costa Rica Côte d’Ivoire Craniology Crick, Francis Croatia Cross-Sectional Study Crossing Over Crossover Study Crude Mortality Rate Cryopreservation Cryosurgery Cuba Cyprus Cystic Fibrosis Cytogenetics Cytokine Czech Republic

D

Daily Reference Values (DRVs) Darwin, Charles Date Rape Da Vinci, Leonardo Deafness Death and Dying Death Rate Degenerative Nerve Diseases Dementia Demographic Transition Dengue Denmark Dental Health

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List of Articles

Department of Energy (DOE) Department of Health and Human Services (HHS) Depression Dermatitis Developmental Disabilities Diabetes Diabetes and Pregnancy Diabetes Type I (Juvenile Diabetes) Diabetes Type II Diabetic Eye Problems Diabetic Foot Diabetic Kidney Problems Diabetic Nerve Problems Diabetic Teeth and Gum Problems Diagnostic Imaging Diagnostic Tests Dialysis Diarrhea Diesel Exhaust Dieting Digestive Diseases (General) Diphtheria Disasters and Emergency Preparedness Disease and Poverty Disease Prevention Diverticulosis and Diverticulitis Dizygotic Twin Dizziness and Vertigo Djibouti DNA DNA Repair Dominica Dominican Republic Double-Blinded Study Doula Down Syndrome Drinking Water Drug Abuse Drug and Medical Device Safety Drug Enforcement Administration (DEA) Dyslexia Dysmorphology Dysphagia Dystonia

E

Ear Disorders Ear Infections East Timor Eating Disorders

Ecogenetics E. Coli Infections Ectoparasites Ecuador Edema Egypt Ehlers-Danlos Syndrome Ehrlich, Paul El Salvador Elbow Injuries and Disorders Elder Abuse Electromagnetic Fields Electrophysiology Emphysema Empiric Risk Employment Retirement Income Security Act (ERISA) Endemic Endocrine Diseases (General) Endocrinology Engram Environmental Health Environmental Medicine Environmental Protection Agency (EPA) Environmental Tobacco Smoke (ETS) Environmental Toxicology Enzyme-Linked Immunosorbent Assay (ELISA) Epidemic Epidemiologist Epidemiology Epigenetics Epilepsy Equatorial Guinea Eritrea Esophageal Cancer Esophagus Disorders Estonia Estrogen Replacement Therapy (ERT) Ethiopia European Association for Cancer Research (EACR) European Association for the Study of Obesity (EASO) European Food Safety Authority (EFSA) European Public Health Alliance (EPHA) European Public Health Association (EUPHA) Evidence-Based Medicine Exercise for Children Exercise for Seniors

Exercise Treadmill Test Exercise/Physical Fitness Extragonadal Germ Cell Tumor Eye Cancer Eye Care Eye Diseases (General)

F

Facial Injuries and Disorders Failure to Thrive Fainting Falls False Negative False Positive Farmer, Paul Federal Emergency Management Agency (FEMA) Fee-for-Service Female Circumcision Fetal Alcohol Syndrome Fever Fiji Filariasis/Elephantiasis Finland Flea Bites Fluoride Folic Acid Fondation Jean Dausset (CEPH) Food Allergy Food and Agriculture Organization of the United Nations (FAO) Food and Drug Administration (FDA) Food Contamination/Poisoning Food Safety Foodborne Diseases Foot Health Foot Injuries and Disorders Forensic Medicine Fractures Framingham Heart Study France Fraternal Twins Fredrickson, Donald Fungal Infections

G

Gabon Gage, Phineas Gallbladder and Bile Duct Diseases Gallbladder Cancer Galton, Sir Francis

List of Articles



Gambia Gastroenterologist Gastroenterology Gastroesophageal Reflux/Hiatal Hernia Gastrointestinal Bleeding Gaucher’s Disease Gay Gene Gel Electrophoresis Gene Array Analysis Gene Mapping Gene Pool Gene Silencing Gene Transfer Generic Drug Genes and Gene Therapy Genetic Brain Disorders Genetic Code Genetic Disorders Genetic Testing/Counseling Genetic Transformation Genetics Genital Herpes Genomic Imprinting Genomic Library Genotype Georgia (Country) Geriatrics Germany Germline Mutation Gerontology Ghana Giardia Infections Gibbon, John H., Jr. Glaucoma Global Health Council Global Health Ethics Glomerular Diseases Goiter Gonorrhea Gout and Pseudogout Greece Grenada Growth Disorders Guatemala Guillain-Barre Syndrome Guinea Guinea-Bissau Gum Disease Guyana Gynecologist Gynecology

H

Hair Diseases and Hair Loss Hair Dye Haiti Hand Injuries and Disorders Haploid Hardy, James D. Hardy-Weinberg law Head and Brain Injuries Head and Brain Malformations Head and Neck Cancer Head Lice Headache and Migraine Health Insurance Portability and Accountability Act (HIPAA) Health Maintenance Organization (HMO) Health Resources and Services Administration (HRSA) Healthcare, Africa Healthcare, Asia and Oceania Healthcare, Europe Healthcare, South America Healthcare, U.S. and Canada Hearing Problems in Children Heart Attack Heart Bypass Surgery Heart Diseases (General) Heart Diseases—Prevention Heart Transplantation Heart Valve Diseases Heat Index Hematologist Hematology Hemizygous Hemochromatosis Hemorrhagic Fever Hemorrhoids Hepatitis Hepatitis C Herbal Medicine Herbal Remedy Herbalism Herbalist Hernia Heroin Abuse Herpes Simplex Heterosexual Heterozygote High Blood Pressure High Risk Pregnancy Hip Injuries and Disorders

xxv

Hispanic American Health Histology Hodgkin’s Lymphoma Homeopathy Homicide Homosexual Homozygote Honduras Hormone Replacement Therapy Hormones Hounsfield, Godfrey Household Poisons Hughlings Jackson, John Human Genome Organisation (HUGO) Hungary Huntington’s Disease Hydrocephalus Hygiene Hyperactivity Hypoglycemia Hypothermia

I

Iceland Immune System and Disorders Immunization/Vaccination Immunologist Immunology Immunosuppression Immunotherapy Impetigo Impotence In Situ In Vitro In Vivo Inbreeding Incidence Incontinence India Indian Health Service (IHS) Indonesia Indoor Air Pollution Infant and Newborn Care Infant and Toddler Development Infant and Toddler Health Infectious Diseases (General) Infertility Inflammatory Bowel Disease Influenza Inhalants Innate Immunity

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List of Articles

Inpatient Institute for Children’s Environmental Health (ICEH) Institute of Medicine (IOM) Institutional Review Board (IRB) Insurance Internal Medicine International Agency for Research on Cancer (IARC) International AIDS Vaccine Initiative (IAVI) International Center for Equal Healthcare Access (ICEHA) International Classification of Diseases (ICD) International Clinical Epidemiology Network (INCLEN) International Committee of the Red Cross (ICRC) International Council of AIDS Service Organizations (ICASO) International Epidemiological Association (IEA) International Federation of Red Cross and Red Crescent Societies (IFRC) International Genetic Epidemiology Society (IGES) International Health Ministries Office (IHMO) International Red Cross and Red Crescent Movement (RCRC) International Society for Environmental Epidemiology (ISEE) International Society for Pharmacoepidemiology (ISPE) International Society of Geographical and Epidemiological Ophthalmology (ISGEO) International Women’s Health Coalition (IWHC) Internist Intestinal Parasites Iran Iraq Ireland Iridology Irritable Bowel Syndrome Israel Italy

J

Jamaica

Japan Joint FAO/WHO Expert Committee on Food Additives (JECFA) Joint United Nations Programme on HIV/ AIDS (UNAIDS) Jordan Juvenile Rheumatoid Arthritis

K

Kazakhstan Kelman, Charles D. Kenya Kidney Cancer Kidney Diseases (General) Kidney Failure and Dialysis Kidney Stones Kidney Transplantation Kiribati Kirklin, John W. Klinefelter’s Syndrome Knee Injuries and Disorders Knockout Korea, North Korea, South Kübler-Ross, Elisabeth Kuwait Kwarshiorkor Kyrgyzstan

L

La Montagne, John Laboratory Tests Lactose Intolerance Laos Latvia Lauterbur, Paul C. Lead Poisoning Lean Body Mass Learning Disorders Lebanon Lederberg, Joshua Leg Injuries and Disorders Legionnaire’s Disease Leishmaniasis Leprosy Lesbian Lesotho Leukemia Leukodystrophies Lewis, Edward B. Liberia

Libya Liechtenstein Lithuania Liver Cancer Liver Diseases (General) Liver Transplantation Locus Longitudinal Study Lou Gehrig’s Disease Low Blood Pressure Low Vision Lung Cancer Lung Transplantation Lupus Luxembourg Lyme Disease Lymphatic Diseases

M

Macedonia (FYROM) Madagascar Maintenance Medication Malaria Malariologist Malariology Malawi Malaysia Maldives Male Genital Disorders Mali Malignant Mesothelioma Malta Managed Care Manic-Depressive Illness Mansfield, Peter Marasmus Marfan Syndrome Marijuana Abuse Marshall Islands Marx, Gertie F. Mauritania Mauritius McClintock, Barbara Me-Too Drug Mead, Margaret Measles Medicaid Medical College Admissions Test (MCAT) Medical Entomology Medical Geography

List of Articles



Medical Helminthology Medical Jurisprudence Medical Physics Medical Prefix Medical Research Council Medical Tourism MedicAlert Medicare Médicins Sans Frontières Medigap Policy MEDLINE Memory Meniere’s Disease Meningitis Menopause Menstruation and Premenstrual Syndrome Mental Health Mercury Meta-analysis Metabolic Disorders Methamphetamine Abuse Methylation Mexico Micronesia Microsurgery Midwife Mine Safety and Health Administration (MSHA) Mismatch Repair Missense Mutation Moldova Molds Monaco Mongolia Monozygotic Twin Morocco Mortality Moscati, St. Joseph Mosquito Bites Mouth Disorders Movement Disorders Mozambique Multiple Chemical Sensitivity Multiple Myeloma Multiple Sclerosis Mumps Muscle Disorders Muscular Dystrophy Myanmar

Myasthenia Gravis Myositis

N

Namibia National Asian Women’s Health Organization (NAWHO) National Association of Health Data Organizations (NAHDO) National Association of People with AIDS (NAPWA) National Breast Cancer Coalition (NBCC) National Cancer Institute (NCI) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) National Center for Complementary and Alternative Medicine (NCCAM) National Center for Environmental Health (NCEH) National Center for Health Marketing (NCHM) National Center for Health Statistics (NCHS) National Center for HIV, STD, and TB Prevention (NCHSTP) National Center for Infectious Diseases (NCID) National Center for Injury Prevention and Control (NCIPC) National Center for Public Health Informatics (NCPHI) National Center on Birth Defects and Developmental Disabilities (NCBDDD) National Cholesterol Education Program (NCEP) National Coalition for Cancer Survivorship (NCCS) National Environmental Health Association (NEHA) National Eye Institute (NEI) National Heart, Lung, and Blood Institute (NHLBI) National Human Genome Research Institute (NHGRI) National Immunization Program (NIP) National Institute of Allergy and Infectious Diseases (NIAID) National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

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National Institute of Biomedical Imaging and Bioengineering (NIBIB) National Institute of Children’s Health (NICHD) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) National Institute of Environmental Health Sciences (NIEHS) National Institute of Mental Health (NIMH) National Institute of Neurological Disorders and Stroke (NINDS) National Institute of Nursing Research (NINR) National Institute of Occupational Safety and Health (NIOSH) National Institute on Aging (NIA) National Institute on Alcohol Abuse and Alcoholism (NIAAA) National Institute on Deafness and Other Communication Disorders (NIDCD) National Institute on Drug Abuse (NIDA) National Institutes of Health (NIH) National Library of Medicine (NLM) National Mental Health Association (NMHA) National Network for Immunization Information (NNii) National Program of Cancer Registries (NPCR) National Women’s Health Organization (NWHO) Native American Health Naturopathy Nauru Nausea and Vomiting Neck Disorders and Injuries Neonatologist Neonatology Nepal Nephrologist Nephrology Netherlands Neural Tube Defects Neuroblastoma Neuroendocrinology Neurofibromatosis Neurologic Diseases (General) Neurologist

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List of Articles

Neurology Neuromuscular Disorders Neuropsychologist Neuroradiologist Neuroradiology Neuroscience Neuroscientist New Zealand Nicaragua Niger Nigeria Nirenberg, Marshall W. Noise Non-Hodgkin Lymphoma Nonsense Mutation North American Association for the Study of Obesity (NAASO) Norway Nose Disorders Nuclear Medicine Nurses’ Health Study Nutrition Nutritionist

O

Obesity Obsessive-Compulsive Disorder Obstetric Fistula Obstetrician/Gynecologist Obstetrics Occupational Health Occupational Injuries Occupational Medicine Occupational Safety and Health Administration (OSHA) Oman Onchocerciasis Oncologist Oncology Ophthalmologist Ophthalmology Optometrist Oral Cancer Oral Rehydration Therapy Oral Surgeon Organ Donation Organ Transplantation Orthomolecular Medicine Orthopedics Orthopedist Osler, Sir William

Osteoarthritis Osteogenesis Imperfecta Osteology Osteonecrosis Osteopathy Osteoporosis Otolaryngologist Otolaryngology Otology Outpatient Ovarian Cancer Over-the-Counter (OTC) Drug Ozone

P

Paget’s Disease of Bone Pain Pakistan Palau Palestine Panama Pan American Health Organization (PAHO) Pancreas Transplantation Pancreatic Cancer Pancreatic Diseases Papua New Guinea Paraguay Paralysis Parasitic Diseases Parathyroid Disorders Parkinson, James Parkinsonís Disease Passive Immunity Pasteur Institute Pasteur, Louis Pasteurization Pathologist Pathology Pathophysiology Pauling, Linus Pediatrics Penile Cancer Peptic Ulcer Perinatologist Perinatology Peripheral Nerve Disorders Peru Pesticides Pharmaceutical Industry (Worldwide) Pharmacist Pharmaco-epidemiology

Pharmacogenetics Pharmacogenomics Pharmacologist Pharmacology Pharmacopeia/Pharmacopoeia Pharmacy Phenotype Phenylketonuria Pheochromocytoma Philippines Phrenology Phylogenetics Physiatrist Physical Therapy Physiology Pituitary Disorders Pituitary Tumor Placebo Pneumonia Podiatrist Point Mutation Point of Service (POS) Poisoning Poland Polio and Post-Polio Syndrome Pollution Polycystic Kidney Disease Polymerase Chain Reaction (PCR) Polymorphism Polymyalgia Rheumatica Porphyria Portugal Postpartum Depression Prader-Willi Syndrome Preeclampsia Preferred Provider Organization (PPO) Pregnancy Pregnancy and Substance Abuse Pregnancy Loss Premature Babies Prenatal Care Prescription Drug Abuse Prevalence Preventive Care Primary Care Proctology Programmed Cell Death Prospective Study Prostate Cancer Prostate Diseases Psoriasis

List of Articles



Psychiatrist Psychiatry Psychoimmunology Psychologist Psychology Psychoneuroimmunology Psychooncology Psychotherapy Public Health Pulmonary Embolism Pulmonary Fibrosis Pulmonology

Q

Qatar

R

Rabies Radiation Exposure Radiologist Radiology Radon Ramsay Hunt, James Randomized Clinical Trial Rare Diseases Raynaud’s Disease Reflex Sympathetic Dystrophy Refractive Errors Refugee Health Rehabilitation Reproductive Health (General) Respiratory Diseases (General) Retinal Disorders Retrospective Study Rett Syndrome Reye Syndrome Rheumatic Heart Disease Rheumatoid Arthritis Rickets Rodbell, Martin Roentgen, Wilhelm Roentgenology Romania Rosacea Rubella Russia Rwanda

S

Sabin, Albert Sabin, Florence R.

Sachs, Jeffrey Safety (General) Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Salivary Gland Disorders Salmonella Infections Samoa San Marino São Tomé and Principe Sarcoidosis Satellite DNA Saturated Fat Saudi Arabia Schizophrenia School Nutrition Association (SNA) Schweitzer, Albert Scleroderma Scoliosis SEER (Surveillance, Epidemiology, and End Results Program) Seizures Senegal Serbia and Montenegro Severe Acute Respiratory Syndrome (SARS) Sexually Transmitted Diseases Seychelles Shingles (Herpes Zoster) Shistosomiasis Shoulder Injuries and Disorders Sickle Cell Anemia Sierra Leone Singapore Sinusitis Sjogren’s Syndrome Skin Cancer Skin Diseases (General) Skin Pigmentation Disorders Sleep Disorders Slovakia Slovenia Small Intestine Cancer Smallpox Smokeless Tobacco Smoking Smoking and Pregnancy Smoking and Youth Smoking Cessation Snellen’s Chart Society for Healthcare Epidemiology of America (SHEA)

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Society for Nutrition Education (SNE) Society for Public Health Education (SOPHE) Soft Tissue Sarcoma Solomon Islands Somalia Somatic Mutation Soper, Fred L. South Africa Spain Speech and Communication Disorders Spider Bites Spina Bifida Spinal Cord Diseases Spinal Cord Injuries Spinal Muscular Atrophy Spinal Stenosis Spleen Diseases Sports Injuries Sprains and Strains Sri Lanka Staphylococcal Infections Stem Cells/Stem Cell Transplantation Stewart, Alice Stickler, Gunnar B. Stomach Cancer Stomach Disorders Streptococcal Infections Stress Stroke Substance Abuse and Mental Health Services Administration (SAMHSA) Sudan Sudden Infant Death Syndrome (SIDS) Suicide Sun Exposure Sun Protection Factor (SPF) Surgery Suriname Swaziland Sweden Switzerland Syria

T

Taiwan Tajikistan Tanner Stages Tanzania Taste and Smell Disorders Tay-Sachs Disease

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List of Articles

Teenage Pregnancy Telepathology Telesurgery Temporomandibular Joint Dysfunction Testicular Cancer Tetanus Thailand Third World Thomas, Lewis Thoracic Outlet Syndrome Thorn, George W. Throat Disorders Thymus Cancer Thyroid Cancer Thyroid Diseases Tick Bites Tinnitus Togo Tonga Tourette Syndrome Toxicology Trachoma Trans Fat Transient Ischemic Attack Travel Medicine Traveler’s Health Tremor Trinidad and Tobago Tropical Medicine Tuberculosis Tuberous Sclerosis Tumor Registry Tunisia Turkey

Turkmenistan Turner’s Syndrome Tuvalu Typhoid

U

Uganda Ukraine Ulcers Ultraviolet Radiation United Arab Emirates United Kingdom United Nations Children’s Fund (UNICEF) United Network for Organ Sharing (UNOS) United States Medical Licensing Examination (USMLE) United States Pharmacopeia and National Formulary (USP-NF) United States Public Health Service United States Statistics Universal Donor Unsaturated Fat Urinary Tract Infections Urological Surgeon Urologist Uruguay Usher Syndrome Uterine Cancer Uterine Diseases Uzbekistan

V

Vaginal Cancer

Vaginal Diseases Vanuatu Varco, Richard L. Vasculitis Venezuela Vietnam Viral Infections Virology Vitamin A Deficiency Vitamin and Mineral Supplements Vitiligo Voice Disorders Voluntary Euthanasia Society (VES) Vulvar Cancer

W

Warshaw, Joseph Watson, James West Nile Virus Western Sahara Whooping Cough Wilkins, Lawson Wilson’s Disease Women’s Health (General) World Health Organization (WHO) Wrist/Arm Injuries and Disorders

Y

Yemen

Z

Zambia Zimbabwe Zoll, Paul M.

List of Contributors Acharya, Utkarsh Ohio University College of Osteopathic Medicine Aenlle, Lisa Michigan State University College of Human Medicine Ajayi, Toyin King’s College, London School of Medicine Ahmad, Aisha St. Joseph Mercy of Macomb Akter, Farhana King’s College, London Alexander, Shelley L. University of Missouri-Kansas City School of Medicine

Bergman, Hagit University of Louisville

Chen, Stephen University of Toronto

Bhatraju, Pavan University of Louisville

Chute, Laura Autumn Independent Scholar

Boslaugh, Sarah E. BJC HealthCare

Clerkin, Cathleen University of California, Berkeley

Boyle, Helen Independent Scholar

Clerkin, Paul J. Sacramento City College

Boyle, Peter Independent Scholar

Corfield, Justin Geelong Grammar School, Australia

Brady, Mark Brown Medical School

Cox, W. Joshua Kansas City University of Medicine and Biosciences

Breitbart, Ross E. Philadelphia College of Osteopathic Medicine

Ali, Ather Yale University

Bumpass, David B. University of Virginia

Ali, S. Harris York University, Toronto

Burns, Melody University of Missouri-Kansas City School of Medicine

Ament, Jared Daniel Harvard Medical School Harvard School of Public Health

Currier, Connie Michigan State University Curry, Christine Independent Scholar Cymet, Tyler Childs Johns Hopkins School of Medicine

Busfield, Joan University of Essex

Darda, Saba Independent Scholar

Barnes, Regan Kansas City University

Chandra, Amit New York Hospital, Queens

Darido, Elias Independent Scholar

Basseri, Robert J. University of Southern California, Los Angeles

Chang, Cindy Cold Spring Harbor Laboratory SUNY Stony Brook

Dasari, Chanukya R. University of Missouri-Kansas City School of Medicine

Bedi, Manpreet University of Missouri-Kansas City

Chaudhari, Bimal P. Boston University

Dasco, Matthew Brown University

Benzekri, Noelle A. UCLA School of Medicine

Chaudhury, Moushumi Boston University

David, Annette M. Health Partners, L.L.C.

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List of Contributors

De Maio, Fernando Simon Fraser University

Gearhart, Shannon Indiana University School of Medicine

de Sanjosé, Silvia Catalan Institute of Oncology, Barcelona, Spain

Ghanbari, Hamid Independent Scholar

Desai, Gautam J. Kansas City University of Medicine and Biosciences Desai, Komal Bharat Independent Scholar Donkor, Martha Edinboro University Dowling, Dennis J. Independent Scholar Drazin, Doniel Albany Medical College Draeger, Nicholas J. Kansas City University of Medicine and Biosciences Dude, Annie University of Chicago Dunbar, Brett D. Independent Scholar Ezra, Navid David Geffen School of Medicine Farooq, Sidrah Independent Scholar Fatima, Quratulain Independent Scholar Fernandez Diaz, Natalia Independent Scholar Fitch, Erin Oregon Health and Science University

Gharipour, Mohammad Independent Scholar Gladwin, Rahul University of Health Sciences, Antigua Glaros, Alan George Kansas City University of Medicine and Biosciences Glaser, Kelli Independent Scholar Gokoffski, Kimberly University of California, Irvine Goldkamp, Jennifer University of Missouri, Kansas City Goldstein, Bradley E. Lake Erie College of Osteopathic Medicine Gowda, Charitha Duke University School of Medicine Grant, Jonelle S. University of North Carolina Grant, William B. Sunlight, Nutrition, and Health Research Center Guffey, Megan K. Independent Scholar Gupta, Nakul Ross University School of Medicine Gurbani, Barkha N. UCLA School of Medicine

Hunt, Tracey A. Kansas City University of Medicine and Biosciences Husseini, Abdullatif Birzeit University, Palestine Ingram, Stephanie F. University of South Florida College of Medicine Jain, Sachin Rush University Medical Center Janes, Matthew University of California, Irvine Janneck, Laura Case Western Reserve University School of Medicine Jeshmaridian, Samvel Sergei American Psychological Association Joshi, Priya P. Chicago Medical School Khan, Karim Independent Scholar Karty, Ann M. Kansas City University of Medicine and Biosciences Kaur, Yasmin St. Matthew’s University Kaushik, Anjan P. University of Virginia Keller, Thomas Christian University of Virginia Kennedy, Justina University of Louisville

Gurbani, Mala University of Southern California

Khan, Omar A. University of Vermont College of Medicine

Hadland, Scott Washington University School of Medicine

Khanderia, Shamoli Private Practice Physician

Foote, Mary University of Arizona

Hamilton, William J. Arizona State University

Kim, Daniel Harvard School of Public Health

Franco-Paredes, Carlos Emory University

Haque, Omar Sultan Harvard Medical School

Kiem, JoAnn Tijn Kon Independent Scholar

Frye, Stacy A. Michigan State University

Hartmann, Daniel University of Heidelberg, Germany

Kim, Lindsay Emory University School of Medicine

Fujioka, Kimberly University of California, Berkeley

Hellawell, Jennifer L. Cornell University School of Medicine

Gagne, Joshua J. Jefferson Medical College

Hissett, Jennifer University of Colorado Health Sciences Center

Kolo, George Kansas City University of Medicine and Biosciences

Garcia, Megan University of Missouri-Kansas City

Hoh, Josephine Yale University Department of Epidemiology and Public Health

Fleg, Anthony UNC Chapel Hill Schools of Medicine and Public Health

Garner, Angela J. University of Missouri-Kansas City School of Medicine

Hohman, Donald W., Jr. St. George’s University

Kulczycki, Andrzej University of Alabama, Birmingham La Flair, Lareina Nadine Harvard Medical School Lathorn, Heather Independent Scholar

List of Contributors

Le, Mai Nhung San Francisco State University

Meiners, Melissa University of Missouri, Kansas City School ‘ of Medicine

Patel, Sangeeta University of Illinois at Chicago College of Medicine

Menon, Priya Johannesburg General Hospital

Patel, Shalu S. University of Michigan

Mexia, Ricardo Independent Scholar

Pilitsis, Julie Rush University Medical Center

Michaud, Lyn Independent Scholar

Pizzorno, Joseph E. Bastyr University

Michon, Heather K. Independent Scholar

Pollard, Vincent Kelly University of Hawaii at Manoa

Liu, Constance W. Case Western Reserve University

Miller, DeMond Shondell Rowan University

Lozada, Jose S. Case Western Reserve University

Monaco, Thiago University of Sâo Paulo Medical School, Brazil

Potru, Rachana Michigan State University College of Human Medicine

Lee, Darrin J. University of California, Irvine Levin, Elizabeth Laurentian University Lim, Joanne University of Southern California List, Justin M. Stritch School of Medicine, Loyola University Chicago

Lunardini, David J. University of Virginia Ly, E. John Brown University Medical School Ma, Shen-Ying Richard University of Virginia Madjar, Ingrid Y. Kansas City University of Medicine and Biosciences College of Osteopathic Medicine Malik, Rizwan Asif Independent Scholar Malouin, Rebecca A. Michigan State University Mamelian, Kristen University of Missouri, Kansas City Manganaro, Christine L. University of Minnesota Martinez, Celina Johns Hopkins University School of Medicine Masood, Quratulain Independent Scholar May, Linda E. Kansas City University of Medicine and Biosciences Mayne, Susan T. Yale University McClain, Rance Kansas City University of Medicine and Biosciences McRae, Mary Peace Kansas City University of Medicine and Biosciences Mehta, Amee Independent Scholar Mehta, Jinal University of Missouri

Prono, Luca Independent Scholar

Morris, Shaun K. Independent Scholar

Purdy, Elizabeth Independent Scholar

Nandi, Deipanjan Duke University School of Medicine

Quinn, John University of Illinois at Chicago

Neu, Denese M. HHS Planning & Consulting, Inc.

Rad, Seyed Ali Mohammadi Michigan Radiological Society

Neff, Duane R. Brandeis University

Raminani, Sudha R. The Fenway Institute

Nguyen, Claire K. Johns Hopkins Bloomberg School of Public Health

Ran, Maosheng University of Guam

Nijhawan, Rajiv I. Independent Scholar Noguchi, Lisa Pittsburgh Medical Center Novogradec, Ann York University, Toronto Ogden, Richard K. Kansas City University of Medicine and Biosciences Padula, Alessandra Università degli Studi, L’Aquila, Italy

Rattan, Rishi University of Illinois–Chicago Richards, Misty Charissa Albany Medical College Roberto, Christina Yale University Robinson, Elliot P. University of Virginia Rodriguez-Morales, Alfonso J. Universidad de Los Andes, Venezuela Rowland, Amy John Jay College of Criminal Justice

Pakes, Barry University of Toronto

Sacks, Emma Columbia University

Palmatier, Jason Independent Scholar

Sagert, Kelly Boyer Independent Scholar

Panjabi, Rajesh University of North Carolina, Chapel Hill Johns Hopkins School of Public Health

Samad, Ahmed S. Hoffmann-La Roche Inc.

Patel, Ashwinkumar Wharton School of the University of Pennsylvania Patel, Pinaki N. Kansas City University of Medicine and Biosciences College of Osteopathic Medicine

Samartzis, Dino Harvard University Sathe, Neha New York University Saunders, Paul Richard Canadian College of Naturopathic Medicine

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List of Contributors

Scheller, Ericka L. Kansas City University of Medicine and Biosciences Schlaefer, Katherine Camino al Cambio Sebley, Caroline Kansas City University of Medicine Sedney, Cara West Virginia University School of Medicine Seetharam, Anil Washington University in St. Louis Sehgal, Akta University of Missouri–Kansas City School of Medicine Shealy, C. Norman Independent Scholar Shekhawat, Nakul Vanderbilt University Shen, Francis H. University of Virginia Shenderov, Kevin New York University Shimizu, Ikue Brown University Medical School Sinclair, Amber University of Georgia Skaouris, Afrodite Northeastern Illinois University Smith, Erin Kansas City University of Medicine Smith, Matthew Jordan Florida State University Soper, Fred L. Independent Scholar Stansbeary, Jeremy John Oklahoma State University Stevenson, Bernadette Mietus University of North Carolina Stickler, Gunnar B. Independent Scholar Strain, Ryan University of Missouri-Kansas City School of Medicine Sturm, Jacquelyn Independent Scholar

Sullivan, Timothy Georgetown University Sundet, Sarah Independent Scholar Tabin, Geoffrey University of Utah School of Medicine Tan, Jonathan SUNY Stony Brook School of Medicine Tavassoly, Iman Mazandaran University of Medical Sciences, Iran Taylor, John M. University of Alberta Tella, Swathi Independent Scholar Taarea, Roberto Independent Scholar Tarigopala, Sweta Independent Scholar Tavassoly, Omid Tarbiat Modares University Terzioglu, Aysecan City University of New York Tatevossian, Tiffany David Geffen School of Medicine at UCLA Than, Khoi D. Johns Hopkins University School of Medicine Thorn, George W. Independent Scholar Tuddenham, Susan Independent Scholar Urajnik, Diana University of Toronto Usera, Phillip Cresswell The Medical School for International Health, Israel Van Opstal, Elizabeth Michigan State University Varco, Richard L. Independent Scholar Vassy, Jason Washington University in St. Louis

Sturzenegger, Amber Kansas City University

Vegosen, Leora Johns Hopkins Bloomberg School of Public Health

Subbarayan, Rishi North Eastern Ohio Universities College of Medicine

Villanueva, Tiago Centro Hospitalar de Lisboa-zona Central, Portugal

Walsh, John Shinawatra University, Thailand Waskey, Andrew J. Dalton State College Watcha, Daena Stanford University Webster, Danielle University of Missouri–Kansas City School of Medicine Webster, Noah J. Case Western Reserve University Wentzell, Emily University of Michigan Willsie, Debra A. University of Missouri–Kansas City Willsie, Sandra Kansas City University of Medicine and Biosciences Winn, Jessica Independent Scholar Winograd, Claudia University of Illinois Wirtz, Andrea Johns Hopkins University School of Public Health Wolinski, Melissa K. Michigan State University Wynne, Ben Gainesville State College Yaman, Aylin Antalya State Hospital Yaman, Hakan Akdeniz University Yeh, James S. Boston University School of Medicine Yelin, Joel C. Rowan University Yoo, Grace San Francisco State University Younger, Jarred Stanford University School of Medicine Yeung, Michael Independent Scholar Zheng, Tongzhang Yale University School of Medicine Zincavage, Rebekah M. Brandeis University

Chronology

8000–10000 b.c.e.: Evidence that healers attended to trauma, set broken bones, assisted at childbirth, and conducted healing rituals. 3100 b.c.e.: First report of use of Chinese herb Ma Huang, also known as ephedrine. 1350 b.c.e.: Earliest recorded epidemic of smallpox. Smallpox spread rapidly throughout the populated world including Egypt, Arabia, Greece and in the second century c.e. had spread into central Europe. 300 b.c.e.: An essential part of Greek thinking is the early idea of balance of the four basic elements: fire, water, air, and earth. To each of these elements there was a bodily humor (blood, black bile, yellow bile, and phlegm). Illness was ascribed to their imbalance. 0 c.e.: At the beginning of the Christian era, the world population is probably about 250 million, a figure that did not change appreciably for a thousand years. 335: Emperor Constantine decrees that infirmaries (early hospitals) must be built in Rome. 700s–800s: First asylums (mental hospitals) built.

1348: Venice develops a 40-day detention period (quarantine) for all incoming vessels as Venetians believed the plague was introduced via ships. Genoa, Marseilles, and other major ports adopted the quarantine. 1400s: Pope Sixtus IV permits autopsies at Bolonga and Padua medical schools. 1530: Contagion theory of disease is articulated by Renaissance physician and scholar Girolamo Fracastoro. In 1530, he also coined the name for syphilis. 1610: First cesarean section is performed on a living woman. 1624: Typhoid fever is described. Typhoid fever is an infectious disease caused by the bacterium salmonella typhi, which multiplies in the bloodstream and gets excreted out via the digestive tract. Late 1640s: Yellow fever epidemic is recorded. Yellow fever is caused by the yellow fever virus, which is carried by mosquitoes. It is now endemic in 33 countries in Africa and 11 countries in South America. 1665: Scientific journals begin publication. The French Journal des sçavans and the English Philosophical xxxv

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Chronology

Transactions of the Royal Society first began systematically publishing research results.

terial disease that primarily affects the nasal passages, throat, and lungs.

1700s: Bristle toothbrushes are introduced. It was during World War II that the concept of brushing teeth really caught on in the United States, in part due to the fact that it was part of American soldiers’ regular daily duty to clean their teeth.

1820s: Tubal sterilization is proposed.

1747: First clinical trial, of citrus fruit for treating scurvy, is conducted. Scurvy is a deficiency disease that results from lack of vitamin C, which is required for correct collagen synthesis in humans. 1750: Word “antiseptic” is first used. Antiseptics are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction. 1751: Giovanni Morgagni’s On the Seats and Causes of Disease as Investigated by Anatomy, containing life and postmortem observations on 700 patients is published. 1785: First clinical description of chicken pox. Chickenpox is caused by the varicella:zoster virus (VZV), also known as human herpes virus 3 (HHV-3), one of the eight herpes viruses known to affect humans. 1785: Placebo is described. 1796: Edward Jenner introduces a modified technique of variolation by using cowpox material. Mass inoculation using cowpox material (called vaccination) was introduced extensively in Britain first and then in all of Europe and other parts of the colonial world. 1802: Health and Morals of Apprentices Act legislated to control abuses of the Industrial Revolution in England. It limits the work of children in textile factories to 12 hours per day, but setting no lower age limit for employment. 1803: Morphine is isolated from opium. 1818: Cholera spread to Southeast Asia, China, Japan, East Africa, the eastern Mediterranean (Syria and Palestine), and southern Russia. 1820s: First description of diphtheria. Diphtheria is a very contagious and potentially life-threatening bac-

1830: Widespread efforts to alleviate many unhealthful conditions begins in England. 1831–1833: The first cholera pandemic to strike England and western Europe takes thousands of lives and quickly spreads to North America via shipping. 1839: “Cell Theory” is introduced. 1839: Vulcanization is discovered, making rubber condoms possible. 1842: Ether is introduced as the first practical anesthetic. Anesthesia has traditionally meant the condition of having the perception of pain and other sensations blocked. 1842: Edwin Chadwick introduced his Report on an Inquiry into the Sanitary Condition of the Labouring Population of Great Britain, a document fundamental in the development of modern public health. 1849: John Snow publishes On the Mode of Communication of Cholera, a work expanded and augmented in 1854 which would become one of the great classics of epidemiological reasoning. 1859: Louis Pasteur suggests that fermentation is caused by living organisms, and that human disease is caused by a similar process. 1851: The First International Sanitary Conference, organized by 12 European nations in Paris, tries to work out the solutions to the “Defense of Europe.” This was the first attempt to reach a consensus on drafting international quarantine regulations. 1854: Italian researcher Filippo Pacini discovers and names the cholera vibrio in the stools and intestine of cholera patients and cited it as the cause of the illness. 1855: Cell division is first described. Cell division is the biological basis of life and enables sexually reproducing organisms to develop from the one-celled zygote.



1859: Charles Darwin’s The Origin of Species is published. Darwin summarized his theory of evolution through natural selection. 1863: International Committee of the Red Cross is founded. The Red Cross was the first nongovernmental organization (NGO), founded by a Swiss national inspired by the terrible suffering of soldiers. 1868: First employee and employer-sponsored health insurance program is established. 1870: French physiologist Paul Bert publishes Barometric Pressure, a summary of his pioneering studies on the effects of high and low pressure on human physiology. 1875: Union of sperm and egg nuclei during fertilization is observed. 1879: Germ theory is introduced. The germ theory of disease, also called the pathogenic theory of medicine, is a theory that proposes that microorganisms are the cause of many diseases. 1890: John Simon, the pioneer of English state medicine, surveys progress in public health during the past two centuries in his English Sanitary Institutions. 1880: A Panama Canal building project is started by the French. After 8 years and almost 20,000 deaths from malaria and yellow fever, the French abandoned their effort. 1881: Robert Koch discovers how to grow bacteria in culture, an advance for testing antibiotics. 1889: Baltimore surgeon William Halsted suggests that his nurse wears rubber gloves during surgery and realizes effect on antisepsis. 1890: Antibodies, called antitoxins at the time, are discovered. 1890: Cause of dental caries is discovered. Dental caries, also described as tooth decay, damages the structures of teeth. 1983: French physician, Jacques Bertillon, introduces the Bertillon Classification of Causes of Death at the

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International Statistical Institute in Chicago. A number of countries adopted Dr. Bertillon’s system . 1896: Radium is discovered. Radium is intensely radioactive and is used in medicine to produce radon gas, which in turn is used as a cancer treatment. 1900: Blood types are discovered. The classification of blood is based on the presence or absence of inherited antigenic substances on red blood cells. 1903: Several nations sign International Sanitary Agreement to prevent the spread of yellow fever, cholera, and bubonic plague. 1904: An Edinburgh doctor reports that alcohol, lead, and morphine given to a pregnant woman can harm a developing fetus. 1906: Word “allergy” is coined. Allergies are the immune system’s incorrect response to a foreign substance. 1907: The French government hosts the first international health office, called L’Office International d’Hygeine Publique (OIHP) in 1907 in Paris. OIHP was the first truly international health agency to monitor and report health outbreaks 1909: Rockefeller Foundation begins with some 72,000 shares of stock in Standard Oil of New Jersey. Its purpose was to “Promote the well-being and to advance civilization of the peoples of the United States ... ”. 1910: First gene is mapped to a chromosome. Today, scientists have identified more than 1 million genetic variations that relate to disease risk or drug responses, and predict whether a medicine might be effective, ineffective, or toxic in certain individuals. 1911: Measles proven to be caused by a virus. Measles is a highly contagious infectious disease characterized by fever, cough, conjunctivitis, and a distinctive spreading rash. 1912: Word “vitamins” is coined to describe nutrients, deficiencies of which cause disease. 1913: James B. Waton’s manifesto on behaviorism is published.

xxxviii Chronology

1915: First-known medical transport takes place as the Serbian Army retreats from Albania. 1919: Rickets are attributed to dietary deficiency, shown as preventable and curable with cod liver oil. 1920s: George Papanicolaou introduces the Pap smear test for screening cervical cancer and uterine cancer. 1921: Discovery of insulin to treat diabetes. The disease was reported as an uncommon condition in the developing world at the time.

1946: The International Monetary Fund is developed representing 182 member countries who promote monetary cooperation, economic growth, and temporary financial assistance in other to help balance payment adjustments through surveillance and technical assistance. 1946: United Nations Children’s Fund (UNICEF) is established.

1922: Cures of cancer with radiotherapy reported.

1947: Nuremberg Code is promulgated. The Nuremberg Code is a set of principles for human experimentation set as a result of the Nuremberg trials at the end of World War II.

1923: League of Nations Health Organization forms. A series of basic clinical field research studies on medicine and public health are undertaken.

1948: World Health Organization (WHO) is founded. The WHO, the primary global health organization in the world.

1924: Last outbreak of bubonic plague in the United States begins. Last reported U.S. cases of human-tohuman plague transmission occurs. 1927: Pregnancy test is invented.

1949: Framingham Heart Study is launched. The Framingham Heart Study is a cardiovascular study based in Framingham, Massachusetts. The study began with 5,209 adult subjects from Framingham, and is on its third generation of participants today.

1928: First antibiotic drug, penicillin, is discovered by Scottish scientist Sir Alexander Fleming.

1950: Studies conclude there is strong evidence that smoking cigarettes causes lung cancer.

1934: Mumps shown to be caused by virus. Mumps is a viral infection that primarily affects the parotid glands.

1950: Chinese government announces it wants to reconcile traditional Chinese medicine and Western medicine into a single system.

1936: Cystic fibrosis (CF) is described. Cystic fibrosis is an inherited disease that affects breathing and digestion. 1937: First U.S. blood bank is established in Chicago. 1937: The West Nile Virus is first isolated in a human in Uganda. West Nile Virus is spread by vector transmission where a living organism passes the virus to the human. 1940: One of four viruses that cause dengue fever is discovered. 1945: First water fluoridation program is launched in Michigan. 1946: Communicable Disease Center, which developed into the Centers for Disease Control and Prevention, is founded.

1953: Structure of DNA is discovered. Watson and Crick published their results on DNA structure in the April 25, 1953 issue of Nature. The model of the DNA as a double helix revolutionized research. 1954: Field trials of polio vaccine begin. Polio is an acute viral infectious disease which is spread from person to person via the fecal–oral route. 1958: WHO recommends launching the Eradication of Smallpox Program at the World Health Assembly. 1958: The International Standards for Drinking Water are published. In this instance the term “standards” was used to be applied to the suggested criteria of water quality. 1958: Cardiopulmonary resuscitation (CPR) is discovered. It is an emergency first aid procedure for a



victim of cardiac arrest. It is part of the chain of survival, which includes early access (to emergency medical services), early CPR, early defibrillation, and early advanced care. 1960: Birth control pill is introduced. The Federal Drug Administration (FDA) approved a drug containing artificial progesterone and estrogen as a contraceptive. 1960: The Center for Health and Population Research is founded by the United States and Pakistan governments to study the epidemiology, prevention, and treatment of cholera. 1962: Rubella virus is isolated. Rubella is a mild disease with signs and symptoms of low-grade fever, swollen lymph nodes in the neck, and a pink rash of many tiny raised bumps on the face, trunk, and extremities. The greatest health concern with rubella is to women in the first trimester of pregnancy and may result in spontaneous abortion. 1962: Rabies virus is observed. Rabies is a serious viral disease that affects the central nervous system. Typically, rabies spreads by way of the saliva of infected animals. 1963: Activities of Daily Living (ADLs) scale first published. ADLs refer to the regular, everyday tasks that are necessary for independent living and self-care. 1964: U.S. Public Health Service launches its first antismoking campaign. 1965: Medicare is signed into law on July 30, 1965 by President Lyndon B. Johnson as an amendment to Social Security legislation. 1965: The International Agency for Research on Cancer (IARC) is established to conduct research on environmental biology and cancer. 1967: First successful heart transplant is completed. 1970: Environmental Protection Agency (EPA) is founded. The EPA is an agency of the federal government of the United States charged with protecting human health and with safeguarding the natural environment. 1971: Australia passes its first law requiring seat-belt use.

Chronology

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1971: Herb used in ancient Chinese medicine to treat malaria, quinghaosu, is proven to be effective. 1971: Family Health International is founded. It is among the largest and most established nonprofit organizations active in international public health. 1972: Clean Water Act is passed. 1972: WHO launches a special program of research, promotion, and development on human reproduction to meet the needs of developing countries. 1972: Medicaid is instituted in the United States as health insurance for the poor. 1973: Surveillance, Epidemiology, and End Results Program (SEER) is established by the National Cancer Institute (NCI) of the U.S. Department of Health and Human Services to collect and study cancer incidence and survival data in the United States. 1973: Supreme Court passes Roe v. Wade, a law legalizing first-term abortion and leaving the regulation of second- and third-term abortions in states’ hands. 1975: WHO, together with the United Nations Development Program (UNDP) and the World Bank, establishes a special program for research and training in tropical diseases. 1975: First case of e. Coli 0157:H7 is reported. Escherichia coli are bacteria of which the virulent strains can cause significant gastrointestinal morbidity and mortality. E. coli O157:H7’s virulence stems from its ability to produce several toxins. 1975: First hybridoma, cell that produces monoclonal antibodies is created. 1975: United Nations Children’s Fund (UNICEF) supports piloting and launch of Integrated Child Development services. Today, this program reaches out to 4.8 million expectant and nursing mothers and 30 million children under six years of age in India per year. 1976: Existence of oncogenes reported by Dr. G. Steve Martin of the University of California, Berkeley. An oncogene is a modified gene, or a set of nucleotides that codes for a protein, that increases the malignancy of a tumor cell.

xl

Chronology

1976: First mass flu (influenza) vaccine program is launched. Each year, the influenza virus changes and different strains become dominant. Due to the high mutability of the virus, a particular vaccine formulation created in labs usually only works for about a year. 1978: First test-tube baby born. 1978: Hepatitis A is grown in culture. Hepatitis A is spread through feces. One can get infected through close contact with an infected person (e.g., changing a diaper or having sexual contact). One also can get infected by eating contaminated food or drinking contaminated water. 1979: Smallpox is eradicated. It was a highly infectious viral disease spread by respiratory discharge, killing 25–30 percent of unvaccinated patients. The virus still exists in at least two laboratories in the world (the CDC and a research institute in Moscow) so that a vaccine can be made in case there is another outbreak. 1980: Congress passes Superfund Act, formerly known as the Comprehensive Environmental Response, Compensation, and Liability Act. 1981: First description of acquired immunodeficiency syndrome (AIDS) is published in Morbidity and Mortality Weekly. 1982: A hepatitis B vaccine is available. Infection due to hepatitis B virus became a global health problem in the late 1980s.

1985: FDA approves the first enzyme linked immunosorbent assay (ELISA) test kit to screen for antibodies to HIV. 1986: The largest-ever radiation accident involving a nuclear reactor occurs at the Chernobyl nuclear power plant in Ukraine. Radioactive contamination spread over large areas of Belarus, the Russian Federation, and Ukraine. 1986: U.S. Surgeon General C. Everett Koop calls for AIDS education for children of all ages, saying that “We can no longer afford to sidestep frank, open discussions about sexual practices, homosexual or heterosexual.” 1987: CDC recommends universal precautions for preventing the spread of infection. 1988: The World Health Assembly resolves to eradicate polio by the year 2000. 1988: Human Genome Project is launched. An international research effort to sequence and map all of the genes—together known as the genome—of members of the human species, Homo sapiens. Completed in April 2003. 1988: The use of radiation sources in medical and other applications is widespread throughout the world. 1988: Condom use is shown to be effective in preventing sexual transmission of HIV. 1990s: At least 11 countries are experimenting with biological weaponry.

1982: The CDC changes the name of the illness called GRID or “gay cancer” to AIDS.

1990: First public health recommendations urging women to have regular mammograms.

1983: Human immunodeficiency virus (HIV) is discovered. HIV emerged as an explosive pandemic by the mid-1980s. As soon as the main modes of transmission of AIDS were identified, a global program on AIDS was initiated in the mid-1980s by WHO.

1990: Around 1 billion people do not have access to a safe water supply, while over 1.7 billion are without adequate sanitation.

1983: A dermatologist from India begins to identify skin lesions from arsenic poisoning on his patients from the Eastern Indian State of West Bengal which shares some aquifers with Bangladesh. 1984: First needle exchange program is introduced in Amsterdam.

1990: American AIDS deaths pass the 100,000 mark —nearly twice the number of Americans who died in the Vietnam War. 1992: National Institutes of Health (NIH) forms Office of Alternative Medicine. 1993: Tuberculosis emerges as a globally dangerous infection.



1994: BRCA2, second breast cancer gene, is located and identified. 1994: Obesity in the United States increases to 22.5 percent from 14.5 percent in 1976. 1995: Hepatitis A vaccine is introduced. Hepatitis A is an acute infectious liver disease caused by the hepatovirus hepatitis A virus. The vaccine will prevent infection from hepatitis A for approximately 15–30 years. 1995: Protease inhibitors (PIs) are introduced. PIs are a class of medication used to treat or prevent infection by viruses, including HIV and hepatitis C. 1997: Scientists clone sheep. 1997: Highly pathogenic avian influenza outbreak in Hong Kong causes 18 cases. Extensive studies of the human cases determined that direct contact with diseased poultry was the source of infection. 1997: China’s immunization program covers more than 95 percent of children. 1997: The first human trials of an AIDS vaccine begin with 5,000 volunteers from across the nation. 1998: WHO initiates a global program called Roll Back Malaria. Malaria remains a threat in about 100 countries, most of which are located in the tropics and subtropics. 1998: Healthy People 2010 is released. It is a nationwide health promotion and disease prevention plan that is composed of 467 specific objectives, 28 goals, and two overarching goals to be achieved by the year 2010. 1998: 134 million children are immunized against polio in a single day in India. 1998: Human embryonic stem cells are cultured. Because of their plasticity and potentially unlimited capacity for self-renewal, Embryonic stem cell therapies have been proposed for regenerative medicine and tissue replacement after injury or disease. 1999: Washington University in St. Louis researchers show that treating rats’ injured spinal cords with immature nerve cells grown from stem cells helps re-

Chronology

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store some function. The research suggests that this technique could one day be used in human spinal cord injury treatment. 2000: EPA signs agreement with 26 other nations to bring down the emissions of several chemicals to reduce smog, acid rain, and other types of environmental damage. 2000: United Nations Millennium Declaration is signed. The Millennium Development Goals are eight goals that 191 United Nations member states have agreed to try to achieve by the year 2015. 2002: The first human cases of SARS are identified. SARS originally involved a zoonotic transmission in which the novel coronavirus crossed over from an animal species to humans, then adapting itself so that it could be transmitted between human hosts. 2002: The Global Fund is created. AIDS, tuberculosis, and malaria are preventable diseases that can be treated effectively. Relative to high-income countries, the burden of these diseases is 30 times greater in developing countries, resulting in economic loss, social disintegration, and political instability. The Fund was created to respond to this challenge. 2004: Road traffic injuries are a deadly scourge, taking the lives of 1.2 million men, women and children around the world each year. Hundreds of thousands more are injured on roads, some of whom become permanently disabled. The vast majority of these occur in developing countries, among pedestrians, cyclists, motorcyclists, and users of public transport, many of whom would never be able to afford a private motor vehicle. 2005: Save the Children, a U.S.-based independent global humanitarian organization, released its annual Mothers’ Index that ranks the best and worst places to be a mother and a child. The index, highlighted in the organization’s State of the World’s Mothers 2005 report, ranks the status of mothers and children in 110 countries based on ten indicators pertaining to health and education. The index reveals that where mothers survive and thrive, children survive and thrive. Scandinavian countries sweep the top rankings of the best places to be a mother, while countries in sub-Saharan Africa dominate the bottom tier. The United States ranks in 11th place.

2007: Former United Nations chief Kofi Annan warns that climate change is likely to be the most urgent humanitarian challenge in the future, highlighting some one million people hit by recent flooding in Africa. Risks to international public health from floods, heat waves, and droughts arising from climate change are becoming the focus of global health organizations and

officials around the world. A range of health problems is expected to accompany rising temperatures worldwide, especially in developing countries, according to Climate Change 2007: Impacts, Adaptation and Vulnerability. Briseis Kilfoy Yale University

A Abortion An abortion is the termination of a pregnancy. It may be spontaneous (also called miscarriage) or induced. About one in five pregnancies ends in spontaneous abortion, typically at an early stage and due to chromosomal abnormality of the conceptus. Such spontaneous embryonic wastage often causes grief for the pregnant woman and is ignored by communities. In contrast, induced abortion (hereafter, abortion) may bring relief from an unwanted pregnancy and is often condemned by societies. Abortion is widely resorted to for birth control; most of the world’s women are likely to have had one or more abortions by the time they complete their childbearing years. Historically, women who underwent abortions risked their personal health and social standing. This situation changed slowly in the 20th century as abortion procedures became much safer and as efforts to legalize abortion gained momentum. Abortion is nowadays a minimum-risk procedure when it is performed by a trained professional in a hygienic setting. But in many countries where it is illegal, and in some where it is legal, unsafe abortion is a common cause of maternal mortality and its complications contribute to serious sequelae for women’s health such as infertility. Despite these realities, abortion

is often stigmatized within medicine and is deeply controversial in some societies and polities. Incidence of Abortion Worldwide, an estimated 46 million pregnancies end in induced abortions each year, nearly half of them in unsafe circumstances. Given that some 210 million pregnancies occur annually, this implies that about 22 percent of all pregnancies worldwide are aborted. However, the incidence of abortion is only known in detail for those countries in which abortion is legally permitted with few restrictions and where official statistics are reasonably complete. The abortion rate refers to the annual number of abortions per 1,000 women of reproductive age. For many years, the lowest abortion rates in the world have been in the Netherlands, Belgium, and Scandinavia (about 5–6/1,000 women aged 15–44). These countries are characterized by a culture of contraceptive responsibility and some of the world’s most liberal abortion laws, with services legal, free, and widely available. The highest abortion rates in the world are found in many former Soviet Bloc republics, where family planning services have been severely lacking. The total abortion rate (TAR) expresses the average number of abortions experienced by a woman during her childbearing years. It is highest in Georgia at 3.7





Abortion

abortions per woman. The TAR declines to low levels as more effective contraceptive methods become available and widely adopted. In the United States, 1.3 million abortions occurred in 2002 and each year, 2 out of every 100 women aged 15–44 have an abortion. At the current rate of 21 abortions per 1,000 women aged 15–44, over one-third (35 percent) of U.S. women will have had an abortion by the time they reach age 45. These levels are higher than in western Europe, Australia, or New Zealand, where contraceptive practice is more widespread and effective. Characteristics of Abortion Patients Both unintended pregnancy and abortion rates are higher among some groups of women. These typically include women under age 30 (especially those aged 20–24), unmarried women, those in poverty, and those with more disadvantaged racial/ethnic minority status. Although it is often assumed that women who have abortions and women who have children are different, in fact they are the same women at different points in their lives. Among U.S. women who have an abortion, 61 percent are already a parent and 52 percent intend to have children or more children in the future. Most women who choose to have an abortion do so because they feel unable in their current circumstances to fulfill their parental responsibilities as they would like, or to provide the kind of family support they believe their children deserve. With improved availability and new technologies for performing abortions, including medication abortion and vacuum aspiration with ultrasound, women are increasingly able to obtain an early-term abortion when it is safer and less traumatic. Within the United States, 9 in 10 abortions occur in the first 12 weeks of pregnancy and 3 in 5 occur at or before eight weeks’ gestation. The proportion carried out at or before six weeks’ gestation has increased from 14 percent of all abortions in 1992 to 25 percent in 2001. Less than 1 percent of women who have had an abortion did so at or after 21 weeks’ gestation. Individual and Societal Determinants of Abortion Women have abortions for many reasons. Most terminate their pregnancies because doing otherwise would limit their ability to meet their current

responsibilities and because they cannot afford the index child at that time. Even if it is dangerous or forbidden, many women will resort to abortion in order to protect their family from poverty or to conceal an illegitimate pregnancy where it is stigmatized. Unwanted pregnancy and unsafe abortion are frequently associated with sexual coercion and violence, particularly in adolescent girls. When asked for their reasons to have an abortion, 74 percent of recent U.S. abortion patients cited concern for or responsibility to other individuals. Almost as many (73 percent) said they could not afford a baby then; 69 percent said that having a baby would interfere with their education, employment, or ability to care for dependents; almost half (48 percent) said they were having relationship problems or would have to raise the child as a single parent; and 38 percent did not wish to have another child because they had already completed their childbearing. The incidence of abortion in society is primarily a function of the incidence of unintended pregnancy, which, in turn, is determined by the level of sexual activity, the age at which women marry, desired family size, and contraceptive knowledge and use. It follows that abortion rates will be higher where desired family size and effective contraceptive use are low, regardless of the legal status of abortion, or cultural and religious sanctions against the practice. Thus, compared to western Europe, abortion rates tend to be several times higher in Latin America and the Caribbean, in many sub-Saharan African countries, and in some Asian countries where contraceptive prevalence is low and access to safe, legal abortion services is limited. The U.S. abortion rate is higher than that found in other Western nations because of the higher proportion of pregnancies that are unintended (almost 50 percent), about half of which are aborted. As fertility preferences fall, both contraceptive use and abortion initially rise. Evidence from a diverse set of countries shows that over time, abortion rates fall as levels of contraceptive use increase further. In South Korea, both contraceptive prevalence and abortion rates increased as the average family size fell by over half between the 1960s and 1980s. After some 20 years, the birth rate began to stabilize, the abortion rate plateaued, and contraceptive prevalence continued to rise. Many Russian women who



wanted only two children had multiple abortions in their lifetimes, largely due to the poor accessibility and quality of contraceptive services and the ready availability of abortion. The situation finally changed in the early 1990s when the government began to promote contraception; over 1988–98, modern contraceptive use increased 80 percent while the abortion rate fell by 53 percent. Abortion Laws, Policies, and Health Consequences Some unintended pregnancies will always occur due to nonuse of contraceptives, difficulties with their use, and contraceptive failure. In addition, pregnancy itself may pose a threat to a woman’s life or to her physical and mental health. Due to such circumstances, almost all countries have adopted laws that allow a pregnancy to be terminated under specified conditions. Nearly all Western democracies permit abortion under broad social and health grounds, enabling women to obtain a medically supervised and extremely safe abortion early in pregnancy. The U.S. Supreme Court ruled in 1973 that restrictive state abortion laws were unconstitutional, thereby legalizing abortion throughout the nation. As in other countries, decriminalization of abortion led to an initial increase in abortion rates that subsequently declined as contraceptive practice improved. At the start of the 21st century, 60 percent of the world’s women were living in countries where early abortion is legally available on broad grounds, with 40 percent able to obtain the procedure on request, that is, without having to specify a reason. One in four (25 percent) were living in countries that allowed abortion only to save a woman’s life or prohibited the procedure altogether; 10 percent of women had legal access to abortion only when deemed necessary to protect a woman’s physical health or life; and 4 percent had access also if needed to protect a woman’s mental health. Of 145 developing countries, abortion was not permitted for rape or incest in 101 countries, for fetal impairment in 108, and for social or economic reasons in 118. It was not allowed even to preserve a woman’s physical health in 65 countries. Abortion is still frequently performed in such countries such that 20 million abortions, or about 41 percent of all procedures worldwide, are il-

Abortion



legal. However, the poor are least likely to get a safe clandestine procedure. Those who are both poor and living in rural areas, without access to hospital care for the complications that may follow an unsafe abortion, are at high risk of death. Access to safe abortion is heavily influenced by the actual implementation of laws and by societal and cultural views on sexuality and reproduction. Latin American countries generally severely stigmatize abortion and permit it only in the event of a threat to a woman’s life. However, safe abortion services are readily accessible for those who can pay for them. India legalized abortion in 1971 but has more abortionrelated deaths than any other country. Many women are unaware of the law, few primary health centers provide service despite being mandated to do so, and procedures are often performed by untrained persons in unhygienic conditions. Legal abortion does not guarantee safety in an environment where broad access to services under sanitary conditions is impeded or where providers are not trained. Restrictive laws and policies are invariably associated with a high incidence of unsafe abortion. When Romania banned access to abortion and contraceptive services in 1966, maternal deaths soared from 20 in 100,000 live births to as high as 150 in 1983. After the procedure was legalized again in 1990, maternal mortality fell sharply from 159 to 83 deaths/100,000 live births within a year and continued to fall thereafter. This fall coincided with a rapid rise in contraceptive prevalence as access to modern contraceptives improved. Hospital admissions for septic and incomplete abortion also fell sharply after South Africa legalized abortion in 1997. Each year, about 19 million women undergo unsafe abortions; 97 percent of these are in developing countries. One-third of these women will suffer serious complications, but fewer than half will obtain the hospital treatment they need. Unsafe abortion causes annually about 68,000 deaths, most attributable to hemorrhage, infection, and poisoning from substances used to induce abortion. Although unsafe abortion is preventable through cheap, effective interventions, almost 100 million women alive today will experience the risk and trauma of an unsafe abortion during their lifetimes if no new actions are taken. African women experience the greatest risk of death from unsafe abortions, with a ratio of 1 in 150



Abortion

compared to Asia’s 1 in 250, Latin America’s 1 in 800, and northern countries’ 1 in 3,700. The consequences are especially serious for poor, young, and uneducated women. Morbidity from unsafe abortion burdens impoverished healthcare services and consumes scarce resources. The cost of providing safe abortion services would be many times lower. In more affluent countries, legal abortion is one of the safest procedures in medical practice, with case fatality rates below 1 death per 100,000 procedures. Abortion is far less likely than an injection of penicillin to cause death and is considerably safer than carrying a pregnancy to term. Surgical and Medical Methods Vacuum aspiration is the preferred surgical method prior to 12 weeks’ gestation. The vacuum can be generated either by an electric pump or with a handheld plastic syringe. Dilatation and curettage (D&C) remains widely used in developing countries, but carries higher risk and is more painful. Medication abortion performed within nine weeks of the last menstrual period is safe, effective, and acceptable to most women, with fewer than 5 percent of cases needing a subsequent surgical intervention for incomplete abortion. The regimen comprises an initial dose of mifepristone (an antiprogrestogen) followed by a prostaglandin, usually misoprostol. This essentially changes the procedure from one requiring surgical skills to one requiring only patient-management skills and can enable a shift toward earlier abortions, which reduces the risk of complications. Mifepristone, popularly referred to as “the abortion pill” or by its earlier acronym, RU-486, was first approved in France in 1988 and its use for early-term abortion is spreading in many countries. Postabortion Care Postabortion care (PAC) is increasingly being instituted worldwide as a critical healthcare service that can save women’s lives in settings where abortion is performed unsafely. PAC should be offered promptly after all abortions, whether medical or surgical, as well as for miscarriages. It has three essential components. First, emergency treatment of postabortion complications must be provided. Manual vacuum aspiration (MVA) is the preferred procedure for treating

incomplete abortions. It is safer and less expensive than D&C, and can be performed effectively in lowresource settings. Second, postabortion patients need strengthened family planning counseling and contraceptive method provision, both immediately after a procedure and in subsequent follow-up, to better space or prevent subsequent pregnancies. Third, referrals should be provided for other reproductive health services such as sexually transmitted infection (STI) and human immunodeficiency virus (HIV) prevention education, screening, diagnosis, and treatment; screening for sexual and/or domestic violence, with treatment as needed; and for medical, social, and economic services and support. In addition, PAC programs increasingly recognize the need to build partnerships with communities. Abortion can be made both safer and rarer. Improved contraceptive practice is critical to reducing the incidence of abortion. New technologies allow women to obtain earlier and safer abortions. Laws and policies should reflect health concerns. Access to safe abortion can be improved through decreasing administrative barriers to legal abortion services that may be performed under the indications allowed by a country’s law, particularly in public sector facilities. PAC programs increasingly stress a continuum of postabortion care. Much more work is needed in this vital area to prevent unsafe abortion and improve the lives of women and their families. SEE ALSO: Birth Control/Contraception; Infertility; Preg-

nancy Loss; Public Health; Reproductive Health; Sexual Health; Women’s Health. BIBLIOGRAPHY. Heather Boonstra, et al., Abortion in

Women’s Lives (Guttmacher Institute, 2006); CATALYST Consortium, PAC Compilation Document (United States Agency for International Development, 2005); Andrzej Kulczycki, The Abortion Debate in the World Arena (Routledge, 1999); World Health Organization, Safe Abortion: Technical and Policy Guidance for Health Systems (World Health Organization, 2003); World Health Organization, Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2000 (World Health Organization, 2004). Andrzej Kulczycki, Ph.D. University of Alabama at Birmingham

Acid Reflux



Abse, Dannie (1923– ) Dannie Abse, a Welsh writer and pulmonologist, is considered one of Britain’s most important contemporary poets. Abse’s poems, plays, essays, and novels have met both critical and popular success due to his ability to signify universal themes through frank depictions of daily life. His writing is influenced by his experience of his Welsh nationality and his Jewish heritage, his occupation as a physician, and a strong awareness of social issues. Abse was educated at the University of Wales, Kings College in London, and Westminster Hospital, and received his medical license in 1950. He spent four years in the Royal Air Force, and in 1955 joined the London Chest Clinic. He has served both as a physician and a freelance writer until his recent retirement from medical practice. Abse published his first collection of poems, After Every Green Thing (1948) while in medical school, and has since published over 20 works, including novels, books of poetry, and memoirs. He had three children with art historian Joan Mercer, his wife of over 50 years until her death in 2005. Abse’s early work does not focus on his identity as a physician. He began to explicitly incorporate his medical experiences into his work early in the 1960s. He writes frequently about the tension between his clinical and literary identities: the symbolic “white coat” and “purple coat” figure repeatedly in his poetry. Abse’s social consciousness extends too to his regard of the medical profession in his consideration of medical ethics. Funland and Other Poems (1973) is considered one of his best volumes of poetry. One of his most famous medical poems, “In the Theatre (A True Incident),” can be found as a part of this volume. Among the many awards he has received are the Arts Council of Wales Literature Award for his volume of Selected Poems (1970) and his play Pythagoras (1979), a Jewish Chronicle Book Award (1970), and the Cholmondeley Award in 1985. Abse has also served as a Senior Fellow of the Humanities at Princeton University (1973–74), President of the Poetry Society (1978–92), was named a Fellow of the Royal Society of Literature in 1983, and a Fellow of the Welsh Academy of Letters in 1992. SEE ALSO: Chekhov, Anton; Da ������������������� Vinci, Leonardo.



BIBLIOGRAPHY. Tony Curtis, Dannie Abse (University of

Wales Press, 1985); The Poetry Archive, “Dannie Abse: Recordings,” www.poetryarchive.org (cited November 2006).

Constance W. Liu, M.D. Case Western Reserve University

Acid Reflux Acid reflux, also known as gastroesophageal reflux disease (GERD) or chronic heartburn, is a medical condition characterized by abnormal backflow of acid from the stomach to the esophagus. It is one of the most common disorders of the gastrointestinal tract and it is estimated that 3 to 4 percent of the population has GERD, while up to 40 percent of the population experience heartburn, the most common symptom associated with GERD, at least once a month. The various causes of acid reflux generally lead to the same symptoms and can be diagnosed through a careful patient history and some diagnostic exams. Treatment ranges from conservative management through lifestyle changes, to the use of medications and potentially to surgery. Possible complications from untreated acid reflux include Barrett’s esophagus and esophageal cancer. In normal individuals, acid is secreted in the stomach to aid in the digestion of food. This acid is usually kept in the stomach and prevented from flowing backward into the esophagus by a zone of constricting muscles called the lower esophageal sphincter (LES). The strength of the LES is also supported anatomically by the muscles of diaphragm. Generally speaking, acid reflux occurs when the LES fails to keep acid and stomach contents from refluxing into the esophagus. The various causes of acid reflux fall into two general categories: decreased strength or tone of the LES and increased stomach filling. Decreased LES tone is associated with pregnancy, smoking, certain drugs (anticholinergic drugs and smooth muscle relaxants), foods (fatty foods, peppermint, chocolate), previous surgery (especially Heller myotomies for achalasia), and hiatal hernias (where the LES is displaced from its normal location below the diaphragm to above it). Increased gastric filling is associated with the ingestion of large meals,



Acne

hypersecretion of acid (as can be seen in ZollingerEllison syndrome), and decreased stomach motility. Symptoms and Diagnosis By far the most common symptom associated with acid reflux is heartburn, which is the feeling of acid from the stomach irritating the lining of the esophagus. While the stomach is equipped to deal with a highly acidic environment, the esophagus is not and therefore acid acts as a strong irritant to the esophagus. Acid can also reflux higher up into the esophagus and enter and irritate the lungs, throat (pharynx, larynx), and mouth. In these cases, patients can develop chest pain, pneumonia, cough, a sour taste in the back of the neck, or even erosion of the dental enamel. Long-term acid reflux can lead to strictures or narrowing of the esophagus due to chronic irritation and can cause dysphagia (difficulty swallowing). The diagnosis of acid reflux is often based on history, but can be confirmed through a trial treatment of medication and other diagnostic exams. Those with symptoms suggestive of acid reflux are started on medical therapy, generally a proton-pump inhibitor, and are followed for response. A resolution of symptoms would confirm the diagnosis and not warrant any further measures. Those who have persistent symptoms require further tests, which can include 24-hour pH monitoring, barium swallow, and esophagoscopy. Treatment and Complications Treatment is aimed at reducing symptoms, healing areas of inflammation, and preventing complications. It ranges from lifestyle changes to medicines to surgery. Lifestyle changes include smaller meals, sleeping with the head of the bed raised, weight loss, smoking cessation, and reducing consumption of aforementioned associated foods and drugs. Medications that are used include H2-blockers and proton-pump inhibitors. The surgical procedure for acid reflux is called a fundoplication (wrapping part of the upper stomach around the LES to reinforce it) and is reserved for those who would require longterm high-dose proton-pump inhibitors. Prolonged and untreated acid reflux can lead to a condition known as Barrett’s esophagus, which is when the cells lining the esophagus change from squamous epithelium (their usual cell type) to columnar epithe-

lium (a cell type found in the intestine) in a process called metaplasia. The change is considered to be a defense mechanism because columnar epithelial cells can secrete mucus that is protective against the acid refluxing into the esophagus. However, the progression to Barrett’s esophagus is considered a step toward developing esophageal cancer. People with Barrett’s esophagus have 30 to 125 times the risk of developing esophageal cancer than the general population. SEE ALSO: Esophageal Cancer; Esophagus Disorders. BIBLIOGRAPHY. Raj Goyal, “Diseases of the Esophagus,”

Harrison’s Principles of Internal Medicine, 16th ed. (McGraw-Hill, 2005); James W. Freston, ed., Diseases of the Gastroesophageal Mucosa: The Acid-Related Disorders, (Springer-Verlag, 2001).

E. John Ly, M.D. Brown University

Acne The everyday pimples and pus-filled papules (small bumps) many adolescents and young adults see on their faces, chests, and backs are known medically as acne. The most frequent form of acne is acne vulgaris. Acne is highly prevalent during puberty and adolescence and may be associated with psychological effects such as reduced self-esteem or depression. Many people see improvement after puberty, but this is not always the case. Acne crosses all racial and social boundaries. It is most common in persons aged 9–19 years and estimates are that 75–95 percent of the adolescent population is affected. However, it has been known to occur in infants and older adults as well. It is estimated that among adults over the age of 25, 40 percent of men and 54 percent of women have some degree of acne. The high prevalence of acne vulgaris is related to the multifactorial nature of the disease. First, it is considered to have a hereditary/genetic component. Second, it is linked to hormone levels in the body, specifically androgens, which are male sex hormones found in both genders (but slightly higher in boys, accounting in part for the increased prevalence in



Acoustic Neuroma



boys). Changes in hormonal activity (during a woman’s menstrual cycle, pregnancy, or stress) may also be associated with the development of acne. In new adult onset acne, a medical disease etiology should be ruled out, such polycystic ovary syndrome in women or Cushing’s syndrome. More commonly though, as during puberty, the increased “sex hormone” activity in both genders leads to increased sebum production by the sebaceous glands. In the genetically susceptible individual, however, there are changes in the keratinocytes (skin cells) lining the pore, whereby the cells become sticky and a clump of cells forms. This cell clumping leads to the development of a comedone, which is the initial step in the development of acne. Subsequently there is an accumulation of dead skin cells, bacteria and sebum in the follicle, to which the skin reacts with an inflammatory defense reaction. In an attempt to try to eliminate these contents, white blood cells are called into the area leading to the typical reaction of heat, redness, pain, and swelling.

warm water and mild antibacterial soap twice a day. The use of an over-the-counter topical treatment containing benzoyl peroxide or salicylic acid can also help to prevent further lesion development. When dealing with a moderate or severe case of acne, a physician can prescribe oral antibiotics, oral contraceptives (for women), topical retinoids, or topical antimicrobials. Typically, a combination of these treatments, such as oral antibiotics and topical retinoids, is necessary. In the case of nodular or severe cystic acne, incision and drainage of the lesions may be required. Furthermore, a physician may also prescribe isotretinion (Accutane) to prevent the development of cysts and new lesions. It is important to note that the treatment of acne takes time to produce results. If there is no noticeable change within 12–16 weeks, the method of treatment may need to be modified. Once there are signs of improvement, it is necessary to continue these treatments in order to prevent recurrences.

Symptoms and Diagnosis Acne vulgaris can be expressed with varying degrees of severity, and is classified as mild, moderate, or severe (nodular-cystic) acne. Mild acne is characterized by the appearance of closed and open comedones, more commonly known as whiteheads and blackheads, respectively. Comedones are characterized by the open hair follicle or pore being clogged (plugged). Closed comedones, or whiteheads, refer to the plug being buried beneath the skin’s surface. In contrast, open comedones, also known as blackheads, are exposed to the surface of the skin and are darkened due to oxidation. Other visible lesions such as papules (small, tender, pink bumps) and pustules (red pimples containing pus) are also an indication of acne. When comedones are accompanied by papules and pustules, it is considered to be a moderate type of inflammatory acne. Some individuals may also have pimples that form below the skin and can be solid (nodules) or filled with pus (cysts). This type of acne is referred to as nodular acne and represents a severe form of the disease.

BIBLIOGRAPHY. American Academy of Dermatology,

Treatment and Management The goal of acne treatment is to prevent the development of new lesions and heal current lesions. For mild acne, this may be achieved by washing the face with

Acoustic neuromas are benign brain tumors derived from Schwann cells (cells that myelinate nerve axons in the peripheral nervous system) that affect cranial nerve VIII, the vestibulocochlear (acoustic) nerve. Acoustic

SEE ALSO: Adolescent Health; Skin Diseases (General).

“What Is Acne?” www.skincarephysicians.com/acnenet (cited June 2006); L. Cordain, S. Lindeberg, M. Hurtado, et al., “Acne Vulgaris: A Disease of Western Civilization,” Archives of Dermatology (v.138, December 2002); Mayo Clinic, “Acne,” www.mayoclinic.com (cited September 2006); National Institute of Arthritis and Musculoskeletal and Skin Diseases, “Questions and Answers about Acne,” www. niams.nih.gov (cited January 2006); National Institute of Arthritis and Musculoskeletal and Skin Diseases, “What Is Acne? Fast Facts: An Easy-to-Read Series of Publications for the Public,” www.niams.nih.gov (cited August 2006). Shalu S. Patel Nidhi J. Avashia Lauren Siliati Independent Scholars

Acoustic Neuroma



Acquired Immunity

neuromas are known by several other names: acoustic schwannomas, acoustic neurinomas, vestibular schwannomas, and vestibular neurilemomas. Symptomatically, acoustic neuromas affect people worldwide at an incidence of 1 per 100,000 person-years; the actual incidence of the disease is even higher considering that many acoustic neuromas are asymptomatic. Acoustic neuromas are more common in people between the ages of 30 and 50. They usually occur unilaterally, with an equal prevalence between the right and left side. Established risk factors for acoustic neuroma include acoustic trauma (chronic exposure to extremely loud noise), parathyroid adenoma, and neurofibromatosis. It should be noted that bilateral acoustic neuromas primarily occur in patients with neurofibromatosis. The clinical presentation of acoustic neuroma depends on the particular nerve that it affects. Almost all patients have involvement of the acoustic nerve, which manifests as hearing loss and tinnitus (a ringing sound in the ear[s]). A majority of patients also have involvement of the vestibular nerve (a branch of the vestibulocochlear nerve), which will present as unsteadiness. A smaller fraction of patients will have involvement of cranial nerve V (trigeminal nerve) and cranial nerve VII (facial nerve). If the former nerve is affected, patients may experience facial numbness or pain; if the latter nerve is involved, symptoms may include facial paralysis and taste disturbances. Tumor progression to involve other brain structures may result in problems with speaking and/or swallowing, ataxia (incoordination), hydrocephalus, and death. Diagnosing acoustic neuromas relies on physical examination, audiometry, and imaging. On physical examination, patients may present with the symptoms mentioned above. Audiometry, a more formal hearing test, shows abnormalities in at least 90 percent of patients with acoustic neuroma. On imaging, magnetic resonance imaging (MRI) is the preferred modality because of its greater power of detection compared to computed tomography (CT). However, CT can be used in patients who cannot tolerate MRI. There are three treatment options for acoustic neuroma: surgery, radiation therapy, and observation. Surgery is a favorable option for otherwise healthy patients because of its extremely high cure rate and very low mortality rate; 98 percent of cases have complete

tumor removal and only 1 percent result in death. Complications after surgery can include cerebrospinal fluid (CSF) leaks, headaches, and cranial nerve palsies. Radiation therapy is also associated with very high success rates and can be used in patients with small (15mm across. In patients who are recent arrivals from countries where TB is prevalent, IV drug users, children