Chen, Robert T.; and Cetron, Martin S., "Yellow fever vaccine: An updated assessment of advanced age as a risk factor for serious adverse events" (2005 AbstractSince 1996, the scientific community has become aware of 14 reports of yellow fever vaccine (YEL)-associated viscerotropic disease (YEL-AVD) cases and four reports of YEL-associated neurotropic disease (YEL-AND) worldwide, changing our understanding of the risks of the vaccine. Based on 722 adverse event reports after YEL submitted to the U.S. Vaccine Adverse Event Reporting System in 1990-2002, we updated the estimates of the age-adjusted reporting rates of serious adverse events, YEL-AVD and YEL-AND. We found that the reporting rates of serious adverse events were significantly higher among vaccinees aged ≥60 years than among those 19-29 years of age (reporting rate ratio = 5.9, 95% CI 1.6-22.2). Yellow fever is a serious and potentially fatal disease. For elderly travelers, the risk for severe illness and death due to yellow fever infection should be balanced against the risk of a serious adverse event due to YEL.

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Spouse abuse is a major social issue in our country. Based on national samples, between 10 and 20% of couples report some type of violence during the course of their marriage. In the United States, 1.8 million women are physically abused by their spouses each year. Within the military, it is estimated that the incidence of spouse abuse is even greater than in the civilian sector. Estimates suggest that one-third of military spouses experience abuse during their marriage. Although 87% of women prefer discussing their victimization with their physician, physicians, as a group, have been least effective in helping them. Recently, several barriers to physician recognition and intervention in domestic violence have been identified, and recommendations for specific training on abuse have been published. This paper provides military physicians an in-depth review of the guidelines to identification, diagnosis, and management of spouse abuse, with a special emphasis on their implementation within the uniformed services.

Purpose: To understand patient attitudes, access toward video calling to enhance efficiency of afterhours triage calls. Methods: We surveyed patients aged 18 to 89 years. Questions included demographics, preferences, access to video calling devices, and perceived advantages and disadvantages of this technology. Answers were entered into Qualtrics database and analyzed using JMP 11 (SAS, Cary, NC). Results: Two hundred ninety-eight patients agreed to participate. Mean age was 47.9 years; 71.6% were female; and 75.1% had access to video calling device. Device proficiency was inversely related to age and greatest in 18-to-32-years group (x 2 = 71.18, P < .0001). Seventy-one percent of patients enjoyed video communication, directly proportional to education (trend test Z = 2.78, P < .005). Adjusted for both age and education, respondents with college education or above were 3 times more likely to self identify as "good' with video (OR, 3.11; 95% CI, 1.48-6.64); those under age 48 had even higher proficiency (Odds ratio (OR), 13.9; 95% CI, 4.79-59.34). Patients with prior video experience were 3 times more likely to prefer video calling (Relative risk (RR) = 3.46; 95% CI, 1.95-6.11). Patients calling their doctor 5 or more times annually preferred video calling significantly more than calling by telephone (RR, 1.61; 95% CI, 1.31-1.97). Faster contact with the primary care provider (19.8%) was the most perceived advantage. Loss of in-person interaction with doctor (37.1%) was the greatest perceived disadvantage. Conclusions: Patients seem to have access and interest in video communication for after-hours calls. Further studies are needed to evaluate whether addition of video component to after-hours triage calls will help reduce unnecessary emergency department visits.