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By: Leonard S. Lilly, MD

bulletProfessor of Medicine, Harvard Medical School, Chief, Brigham and Women's/Faulkner Cardiology, Brigham and Women's Hospital, Boston, Massachusetts


This was the result of a long process and an even longer history of global governance related to allergy testing john radcliffe buy cyproheptadine 4mg online infectious diseases allergy forecast lancaster pa order 4mg cyproheptadine mastercard. In 1896 milk allergy symptoms in 3 month old cyproheptadine 4 mg online, the International Sanitary Conference agreed that there was a need for international health surveillance (Zacher allergy shots vertigo generic cyproheptadine 4mg free shipping, 1999). That year marked the beginning of cooperative Background: Challenges of and Responses to Infectious Disease Threats 13 surveillance for global infectious disease. Eventually requiring the reporting of plague, cholera, yellow fever, smallpox, relapsing fever, and typhus, the impetus for this agreement was that Europe feared that these diseases would enter from poorer countries where they were most prevalent (Fidler, 1997). These regulations were renamed the International Health Regulations in 1969 and were later revised in 1981. Nations have not always complied (Heymann and Rodier, 1998), fearing the economic consequences of preventive actions and reduced travel and trade, even though the reporting of outbreaks often triggers international assistance. In that paper, they provide examples of how "overreaction" to reported outbreaks has had significant consequences for affected nations. The revised regulations are aimed to improve global disease detection and control through public health capacity and compliance. Summary Globalization and the modern-day threats of infectious diseases have kept these diseases on the public policy agenda into the 21st century. Recent policy and programming responses by both the United States and the broader global community provide the context from which we examine the three research questions addressed in this study. This chapter begins with a section describing the evolution of this new paradigm, the effects of infectious disease on security, the implications of a biosecurity policy orientation to natural disease outbreaks, and the implications for global disease reporting. The final section presents the views of stakeholders we interviewed regarding their perceptions of the link between infectious disease and national security. Infectious Disease and Security Evolving Security Concepts Traditional views of the association between infectious disease and security have often focused on the effect of health on military success (for example, see Szreter, 2003). In fact, many health discoveries that were made in the course of efforts to protect armies ultimately benefited other populations as well. State Department has speculated that disease will emerge as a "conflict starter," and possibly even a "war outcome determinant" (see, for example, Center for Strategic International Studies, 2000, and U. Indeed, disease among armies has long been a contributing factor to military outcomes, and warfare has contributed to the spread of disease. The association of disease with warfare parallels traditional views of national security, i. Similarly, traditional views of the relationship between disease and security have focused on the threat of disease spreading across borders. However, increasing worldwide attention has recently been paid to a broader issue: the effect of infectious disease on other concepts of security. These newer concepts include the recognition of the inherent benefit of health: "[H]ealth itself is a power, a fundamental capacity for the development or maintenance of all other capacities" (Berlinguer, 2003, p. Chen and Narasimhan (2003) assert that "a new people-centered paradigm, with its policy and operational implications, can complement and strengthen state security to protect people in an unstable and interconnected world," and "control of global infections is not possible without surveillance, control and response linked to international trade, migration, and movements" (p. Effects of Infectious Disease on Security the discussion of human security versus older, traditional ideas of security is useful in understanding the moral values with which the global community appears to approach the importance of health today. However, it remains somewhat intangible, leaving firm associations between health (including infectious disease) and security incompletely defined. As Chen and Narasimhan (2003) point out, "health and human security are fundamentally valued in all societies, but their connections and interdependencies are not well understood. Such assertions are based on a growing body of evidence that associates infec- Addressing a New Paradigm: Infectious Disease and National Security 17 tious disease with effects that may ultimately threaten both human and national concepts of security. Compelling arguments have been made linking infectious disease to conditions that logically can affect security. These conditions include those mentioned by Brower and Chalk (2003), and others that have been argued by numerous other authors. The following is a summary of research that has associated specific effects of infectious disease with threats to security. The most obvious effect of disease that may result in the instability of a nation or region is the toll of some diseases that have high mortality rates. As detailed in examples later in this chapter, an outbreak of disease-or even the perceived threat of an outbreak-can have significant repercussions on trade and travel for the affected nation. It has been documented that infectious diseases cause significant social disruption through fear and anxiety about a disease (based on accurate or inaccurate information), the loss of people in key social positions due to illness or death, discrimination against groups affected by a disease, and the loss of the majority of (or entire) specific demographic groups. The reduction of this demographic group can lead to economic loss due to reduced productivity, but it also represents the loss of a core group of parents, social leaders, and key members of society, such as teachers and soldiers.

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Such injuries in the primary dentition can interfere with normal development of the permanent dentition allergy testing augusta ga cheap cyproheptadine 4mg without a prescription, and allergy symptoms year round generic cyproheptadine 4mg visa, therefore allergy shots breastfeeding generic 4mg cyproheptadine with amex, significant injuries of the primary incisor teeth are usually managed by extraction allergy medicine dogs can take buy cyproheptadine 4mg mastercard. Even when the teeth appear intact, a dentist should promptly evaluate the patient. Baseline data (radiographs, mobility patterns, responses to specific stimuli) enable the dentist to assess the likelihood of future complications. Trauma to teeth with associated injury to periodontal structures that hold the teeth usually presents as mobile or displaced teeth. Categories of trauma to the periodontium include (1) concussion, (2) subluxation, (3) intrusive luxation, (4) extrusive luxation, and (5) avulsion. Injuries that produce minor damage to the periodontal ligament are termed concussions. Teeth sustaining such injuries are not mobile or displaced but react markedly to percussion (gentle hitting of the tooth with an instrument). This type of injury usually requires no therapy and resolves without com- Chapter 311 Dental Trauma Traumatic oral injuries may be categorized into three groups: (1) injuries to teeth, (2) injuries to soft tissue (contusions, abrasions, lacerations, punctures, avulsions, and burns), and (3) injuries to jaw (mandibular or maxillary fractures or both). The dental therapy of choice depends on the extent of injury, the condition of the pulp, the development of the tooth, time elapsed from injury, and any other injuries to the supporting structures. Therapy is directed toward minimizing contamination in an effort to improve the prognosis. Primary incisors that sustain concussion may change color, indicating pulpal degeneration, and should be evaluated by a dentist. Subluxated teeth exhibit mild to moderate horizontal mobility, vertical mobility, or both. Hemorrhage is usually evident around the neck of the tooth at the gingival margin. Many subluxated teeth need to be immobilized by splints to ensure adequate repair of the periodontal ligament. Intruded teeth are pushed up into their socket, sometimes to the point where they are not clinically visible. Intruded primary incisors can give the false appearance of being avulsed (knocked out). This type of injury is characterized by displacement of the tooth from its socket. The tooth is usually displaced to the lingual (tongue) side, with fracture of the wall of the alveolar socket. These teeth need immediate treatment; the longer the delay, the more likely the tooth will be fixed in its displaced position. Therapy is directed at reduction (repositioning the tooth) and fixation (splinting). In addition, the pulp of such teeth often becomes necrotic and requires endodontic therapy. Extrusive luxation in the primary dentition is usually managed by extraction because complications of reduction and fixation may result in problems with development of permanent teeth. If avulsed permanent teeth are replanted within 20 min after injury, good success may be achieved; if the delay exceeds 2 hr, however, failure (root resorption, ankylosis) is frequent. The likelihood that normal reattachment will follow replantation of the tooth is related to the viability of the periodontal ligament. Parents confronted with this emergency situation can be instructed to do the following: 1. After plugging the sink drain, hold the tooth by the crown and rinse it under running tap water. The initial signs of complications associated with replantation may appear as early as 1 wk post trauma or as late as several years later. Every child or adolescent who engages in contact sports should wear a mouth guard, which may be constructed by a dentist or purchased at any athletic goods store. Helmets with face guards should be worn by children or adolescents with neuromuscular problems or seizure disorders to protect the head and face during falls. All children or adolescents with protruding incisors should be evaluated by a pediatric dentist or orthodontist. Children who experience dental trauma may also have sustained head or neck trauma, and, therefore, neurologic assessment is warranted. Tetanus prophylaxis should be considered with any injury that disrupts the integrity of the oral tissues.

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bulletVitamin E
bulletCryptosporidium enterocolitis (or other protozoal infections)
bulletX-rays of the joints, chest, or stomach area (abdomen)
bulletMedicine (antidote) to reverse the effects of the poison
bulletNausea and vomiting
bulletAlcohol consumption
bulletWhat other symptoms do you have?
bulletEventually leads to difficulty lifting, climbing stairs, and walking