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Siphonaptera of North America north of Mexico: Ischnopsyllidae.

The four genera and 11 species of bat fleas known to occur in North America north of Mexico are reviewed with respect to their distribution and host preferences. All are found on hosts belonging to the bat family Vespertilionidae except Sternopsylla distincta (Rothschild, 1903) and Hormopsylla trux Jordan, 1950, which parasitize species of Molossidae. Keys are provided for the genera and species and their diagnostic characters are illustrated.

Animals↗

Siphonaptera of North America north of Mexico: Vermipsyllidae and Rhopalopsyllidae.

The six species of Chaetopsylla Kohaut, 1903, two species of Polygenis Jordan, 1939, and one species of Rhopalopsyllus Baker, 1905 known to occur in North America north of Mexico are reviewed with respect to their host preferences and distribution. Keys are provided for the species, and their salient characters are illustrated.

Animals↗

Siphonaptera of North America north of Mexico: Hystrichopsyllidae s. str.

The three species of Atyphloceras Jordan & Rothschild, 1915 and the four species of Hystrichopsylla Taschenberg, 1880 known to occur in North America north of Mexico are reviewed with respect to their host preferences and distribution. Keys are provided for the species, and their diagnostic characters are illustrated.

Animals↗

Prevalence, awareness, treatment and control of hypertension in North America, North Africa and Asia.

Results from national surveys of prevalence, awareness, treatment and control provide the most meaningful basis for assessing the burden of hypertension in the community. National surveys conducted in a variety of countries in North America, Europe, Australia, Asia and Africa have identified a strikingly similar relationship between age and blood pressure (BP), with a progressive and steep increase in systolic BP throughout adult life and a less steep increase in diastolic BP from adolescence until the fifth or sixth decade. In most countries surveyed, there was a high prevalence of hypertension. Approximately, one quarter of all adults in the United States and Egypt had hypertension (systolic BP>/=140 mmHg or diastolic BP>/=90 mmHg or use of antihypertensive medication) in national surveys conducted in 1988-1991 and 1991-1993, respectively. The corresponding percentage was somewhat lower (14.4%) for adults surveyed in China during 1991, but temporal trends indicate that the prevalence of hypertension is increasing rapidly in that country. In the 1988-1991 national survey, more than 25% of US adults were unaware of their diagnosis, only 55% were being treated with antihypertensive medication and only 29% were on antihypertensive medication with a systolic/diastolic BP >140/90 mmHg. The situation was much worse in Egypt and China, with only 8% and <5% of adults with hypertension, respectively, being treated with antihypertensive medication and having a systolic/diastolic BP <140/90 mmHg. These survey results underscore the fact that hypertension is highly prevalent, poorly treated and controlled, and an escalating health challenge in economically developing countries.

Africa, Northern↗

Key characters for identifying Aedes bahamensis and Aedes albopictus in North America, north of Mexico.

Aedes bahamensis, a species recently introduced into southern Florida represents the first member of the subgenus Howardina to be found in the United States. Its separation from all other Nearctic Aedes is the subject of this work, integrating it into the North American mosquito keys (Darsie and Ward 1981). The key revisions presented are expanded to include the other exotic species now found in the United States, Aedes albopictus.

Aedes↗

Development of specialist and advanced practice in North America.

North American literature provides interesting ideas about the nature of specialist and advanced practice which are useful in informing British thinking on these subjects. However, the two roles do not have the same meanings as their British counterparts. Clarification of the terminology used and the roles described are essential if we are to understand the concepts. This article presents an overview of the literature about clinical nurse specialist and advanced practitioner roles within North America and identifies differences and similarities between the two.

Career Mobility↗

The medical impact of tornadoes in North America.

North America suffers some of the most severe tornado disasters of any location on the planet. Significant injury and economic impact may result from these storms, particularly in rural areas. Tornadic storms present unique problems for prehospital and Emergency Department personnel. Soft tissue injuries seen after tornadoes are contaminated with polymicrobial flora and may require delayed primary closure. Fractures are a frequent cause of hospital admission and head injury is a frequent cause of death. Advanced warning and proper sheltering actions by a population are the most significant factors in reducing morbidity and mortality. This article reviews the pertinent literature on the medical impact of tornadoes and details the mechanisms of injury, nature of injuries, pre-hospital and ED planning points associated with tornadic storms.

Canada↗

Variation in patient management and outcomes for acute coronary syndromes in Latin America and North America: results from the Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial.

BACKGROUND: Although more than 9500 patients have been enrolled in major clinical trials in Latin America, practice patterns in this region have rarely been examined. We sought to compare characteristics, resource utilization, and outcomes of patients treated for acute coronary syndromes in Latin America with those in North America. METHODS: The Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Theraphy Trial (PURSUIT) enrolled 10,948 patients with non-ST-segment elevation acute coronary syndromes, including 585 in Latin America and 4358 in North America. We analyzed regional differences in patient groups, treatment patterns, and outcomes and used logistic regression analysis to identify association of enrollment region and survival. RESULTS: For patients in Latin America, the length of hospital stay was significantly longer (10 [7, 15] days vs 6 [4, 9], P <.001). Angiograms, angioplasty, and bypass surgery were significantly less common in Latin America (46.2%, 17.6%, and 11.3% vs 79.4%, 33.6%, and 19.4%, P <.001). Thirty-day death/myocardial infarction was not significantly higher, although mortality alone was significantly higher (6.8% vs 3.1%, P <.001). After adjustment for baseline characteristics, enrollment in Latin America remained an independent predictor for death at 30 days (odds ratio [OR] [95% confidence interval (CI)] 2.42 [1.60-3.67]) and persisted at 6 months (OR [95% CI] 2.5 [1.8-3.4]). CONCLUSIONS: Latin American patients treated for acute coronary syndromes were managed less invasively and were twice as likely as their North American counterparts to die within 6 months. This mortality difference was not explained by imbalances in baseline risk.

Angina, Unstable↗

Controlling hepatitis B virus transmission in North America. The North American Regional Study Group.

In the US in 1988, 54,011 cases of viral hepatitis were reported to the Centers for Disease Control (CDC), 42% of which were categorized as hepatitis B. Because of incomplete reporting and subclinical disease, the CDC estimates that approximately 300,000 acute cases of hepatitis B are occurring in the US each year for an annual estimated incidence of 125 cases per 100,000 population. Since 1985, a gradual decrease in the reported incidence of hepatitis B has been observed which may be attributed partly to the availability of new hepatitis B vaccines. Comprehensive control of hepatitis B infection in North America has, however, been impeded by the diversity and mobility of high-risk groups who often are unaware of their potential to infect other individuals. Surveillance studies have indicated that the modes of transmission of hepatitis B may be changing in the US. A larger proportion of cases are seen in parenteral drug abusers and in active heterosexuals. It is believed that hepatitis B vaccine has been administered to only 7% of the population who are at risk of acquiring hepatitis B virus (HBV). To achieve maximum control, universal immunization of infants will therefore be necessary. A first programme, already inaugurated in the US, involves screening of all pregnant women and providing appropriate prophylaxis to neonates of hepatitis B surface antigen-positive mothers and to susceptible household contacts of these individuals. Along with mandatory guidelines, collaboration between the hepatitis community, vaccine manufacturers, the CDC and appropriate medical, legislative and health care organizations should be fostered to achieve successful control of HBV in North America.

Adolescent↗

BETR North America: a regionally segmented multimedia contaminant fate model for North America.

We present the Berkeley-Trent North American contaminant fate model (BETR North America), a regionally segmented multimedia contaminant fate model based on the fugacity concept. The model is built on a framework that links contaminant fate models of individual regions, and is generally applicable to large, spatially heterogeneous areas. The North American environment is modeled as 24 ecological regions, within each region contaminant fate is described using a 7 compartment multimedia fugacity model including a vertically segmented atmosphere, freshwater, freshwater sediment, soil, coastal water and vegetation compartments. Inter-regional transport of contaminants in the atmosphere, freshwater and coastal water is described using a database of hydrological and meteorological data compiled with Geographical Information Systems (GIS) techniques. Steady-state and dynamic solutions to the 168 mass balance equations that make up the linked model for North America are discussed, and an illustrative case study of toxaphene transport from the southern United States to the Great Lakes Basin is presented. Regionally segmented models such as BETR North America can provide a critical link between evaluative models of long-range transport potential and contaminant concentrations observed in remote regions. The continent-scale mass balance calculated by the model provides a sound basis for evaluating long-range transport potential of organic pollutants, and formulation of continent-scale management and regulatory strategies for chemicals.

Air Movements↗

Fate of biological control introductions: monitoring an Australian fungal pathogen of grasshoppers in North America.

In North America there are two generally recognized pathotypes (pathotypes 1 and 2) of the fungus Entomophaga grylli which show host-preferential infection of grasshopper subfamilies. Pathotype 3, discovered in Australia, has a broader grasshopper host range and was considered to be a good biocontrol agent. Between 1989 and 1991 pathotype 3 was introduced at two field sites in North Dakota. Since resting spores are morphologically indistinguishable among pathotypes, we used pathotype-specific DNA probes to confirm pathotype identification in E. grylli-infected grasshoppers collected at the release sites in 1992, 1993, and 1994. In 1992, up to 23% of E. grylli-infected grasshoppers of the subfamilies Melanoplinae, Oedipodinae, and Gomphocerinae were infected by pathotype 3, with no infections > 1 km from the release sites. In 1993, pathotype 3 infections declined to 1.7%. In 1994 grasshopper populations were low and no pathotype 3 infections were found. The frequency of pathotype 3 infection has declined to levels where its long-term survival in North America is questionable. Analyses of biocontrol releases are critical to evaluating the environmental risks associated with these ecological manipulations, and molecular probes are powerful tools for monitoring biocontrol releases.

Animals↗

Origin of extant domesticated sunflowers in eastern North America.

Eastern North America is one of at least six regions of the world where agriculture is thought to have arisen wholly independently. The primary evidence for this hypothesis derives from morphological changes in the archaeobotanical record of three important crops--squash, goosefoot and sunflower--as well as an extinct minor cultigen, sumpweed. However, the geographical origins of two of the three primary domesticates--squash and goosefoot--are now debated, and until recently sunflower (Helianthus annuus L.) has been considered the only undisputed eastern North American domesticate. The discovery of 4,000-year-old domesticated sunflower remains from San Andrés, Tabasco, implies an earlier and possibly independent origin of domestication in Mexico and has stimulated a re-examination of the geographical origin of domesticated sunflower. Here we describe the genetic relationships and pattern of genetic drift between extant domesticated strains and wild populations collected from throughout the USA and Mexico. We show that extant domesticates arose in eastern North America, with a substantial genetic bottleneck occurring during domestication.

Agriculture↗

Meningococcal disease and vaccination in North America.

In North America, meningococcal disease occurs at a rate of I case per 100000 population per year, producing 2725 cases notified in the US in 1998 and 155 laboratory confirmed cases in Canada in the same year. A majority of these cases occur in the winter season and in early childhood, with a case fatality rate of approximately 10%. There has been an increase in the proportion of cases due to serogroup Y meningococci over the past decade: in 1995-98 in the US, 33% of cases were due to serogroup B, 28% were due to serogroup C and 34% were due to serogroup Y; in Canada in 1995-96, 47% of cases were due to serogroup B, 40% were due to serogroup C and 10% were due to serogroup Y. Outbreaks due to serogroup C were more common in the 1990s in the US and a number of outbreaks have occurred in Canada due to organisms from the hypervirulent ET-37 complex. College freshmen in the US in dormitories were found to be at an increased risk of disease. In addition, over the past 10 years, an outbreak of serogroup B disease occurred in the Pacific North-west of the US, with a fourfold increased rate of disease in that region. The explanations for these changes in epidemiology are unknown, but probably reflect the appearance of hypervirulent clones of meningococci and/or changing levels of population immunity. Meningococcal serogroup C polysaccharide-protein conjugate vaccines have been introduced recently in the UK, seem efficacious and offer the potential to reduce the burden of disease in the US and Canada too. Because serogroups other than serogroup C are prevalent in North America, a combination polysaccharide-protein vaccine, including C, Y and possibly W135 serogroups, would be attractive for this population. Although not currently an issue in industrialized nations, inclusion of serogroup A conjugates in any future vaccine policy would be an important decision in driving global prevention of meningococcal disease. A meningococcal conjugate vaccine against serogroup C was licensed in Canada in April 2001.

Adolescent↗

A randomized controlled trial of interventions to promote cervical cancer screening among Chinese women in North America.

BACKGROUND: North American Chinese women have lower levels of Papanicolaou (Pap) testing than other population subgroups. We conducted a randomized controlled trial to evaluate the effectiveness of two alternative cervical cancer screening interventions for Chinese women living in North America. METHODS: Four hundred and eighty-two Pap testing underutilizers were identified from community-based surveys of Chinese women conducted in Seattle, Washington, and Vancouver, British Columbia. These women were randomly assigned to one of two experimental arms or control status. Several Chinese-language materials were used in both experimental arms: an education-entertainment video, a motivational pamphlet, an educational brochure, and a fact sheet. Women in the first experimental group (outreach worker intervention) received the materials, as well as tailored counseling and logistic assistance, during home visits by trilingual, bicultural outreach workers. Those in the second experimental group (direct mail intervention) received the materials by mail. The control group received usual care. Follow-up surveys were completed 6 months after randomization to ascertain participants' Pap testing behavior. All statistical tests were two-sided. RESULTS: A total of 402 women responded to the follow-up survey (83% response rate). Of these women, 50 (39%) of the 129 women in the outreach group, 35 (25%) of the 139 women in the direct mail group, and 20 (15%) of the 134 women in the control group reported Pap testing in the interval between randomization and follow-up data collection (P<.001 for outreach worker versus control, P =.03 for direct mail versus control, and P =.02 for outreach worker versus direct mail). Intervention effects were greater in Vancouver than in Seattle. CONCLUSION: Culturally and linguistically appropriate interventions may improve Pap testing levels among Chinese women in North America.

Adult↗

Strong founder effect in Drosophila pseudoobscura colonizing New Zealand from North America.

The North American native species Drosophila pseudoobscura was first identified in New Zealand in the last few decades. Here, we have studied the genetic consequences of its spread across the Pacific Ocean. Using 10 microsatellites that are highly variable in North American populations, we found that the New Zealand population has substantially fewer alleles, a much lower average heterozygosity, and significantly different allele frequencies at these loci. We have discussed the relative sensitivity of these parameters for detecting the founding event. X-linked loci were more strongly differentiated between continents than autosomal loci, as reflected by larger changes in allele frequencies and greater reductions in numbers of alleles and average heterozygosity. The severity of the genetic diversity loss supports a scenario of a few D. pseudoobscura females being introduced to New Zealand from North America.

Alleles↗

Violence against women in North America.

Although North America is viewed as a place where women have equal rights and status, violence against women is still rampant. Forty to 51% of women experience some type of violence in their lifetime including child abuse, physical violence, rape and domestic violence. The perpetrator is most likely to be a current or former partner. Such violence stems from historical views of women as property and may flourish because of the public's reluctance to get involved in family matters. The concept of violence has been expanded to include non-traditional types such as sexual harassment, breeches of fiduciary trust and stalking. Treatment of victims of violence must include ensuring their safety, encouraging them to make healthy choices and helping them to understand they are not at fault. Education at all levels is required to change attitudes which perpetuate violence despite laws which forbid it.

Crime Victims↗