Mortality and morbidity patterns in modern conflicts

The nature of conflict has changed considerably during the course of the past hundred years. No longer do young men don uniforms and fight each other far from major population centers. Today's battles do not take their toll only on soldiers. Instead, in our world, 90 percent of the victims of conflict are civilians, whether specifically targeted or innocent bystanders caught up in battles through no intention of their own (see Table 11.1). It is in civilian groups that most excess morbidity and...

Lyme disease and the suburbs

Suburbanization has greatly altered the epidemiological landscape. The steady rise in human Lyme disease incidence in the northeast over the last three decades is related to landscape modification through suburbanization (Maupin et al., 1991 Barbour and Fish, 1993 Frank et al., 1998). Eastern deciduous forest communities were fragmented by suburban development, resulting in a habitat matrix that is ideal for deer and some small rodents, especially the white-footed mouse (Daily and Ehrlich,...

Epidemiologic principles as applied to bioterrorism

A World Health Organization (WHO) model based on the hypothetical effects engendered by the intentional release of 50 kilograms of aerosolized anthrax spores upwind from a population center of 500,000, a moderate-sized city, estimated that the agent would disseminate in excess of 20 kilometers downwind and that between 84,000 and 210,000 people would be killed or injured by the event, depending on whether the area was in a developed or developing country (WHO, 1970). The complete WHO...

Overview global scope and cost of antibiotic resistance

Before discussing the social determinants of antibiotic resistance, we must place the problem into a context that considers its global scale, clinical importance, and economic impact. Gram-negative bacteria containing extended spectrum beta-lactamases (ESBLs), that hydrolyze third-generation cephalosporins and most other beta-lactam antibiotics, have a global presence. In 2003, the Study for Monitoring Antimicrobial Resistance Trends (SMART) collected intra-abdominal wound culture isolates from...

Historical distribution of Lyme disease vectors in the US

Since the late 1980s, three major foci of Lyme disease in the US have been identified and account for the vast majority of cases reported each year (Barbour and Fish, 1993). The most significant in terms of case numbers is in the northeastern and mid-Atlantic regions, followed by the upper midwestern region of Wisconsin and Minnesota. Disease transmission in both areas is due to the presence of I. scapularis. A third focus, encompassing northern California, Oregon, and Washington, is...