Background: Parkinson's disease (PD) is a common, progressive neurodegenerative disorder, recognized by the motor symptoms of bradykinesia, tremor, rigidity, and postural impairment. At clinical onset, extensive amounts of dopaminergic neurons have already been lost. The duration of this prodromal phase is uncertain, and it is thought to include predominantly non-motor symptoms. The progressive nature and the symptoms of PD are disabling and reduces the quality of life. Among patients affected in working age, early cessation of employment is common, and such socioeconomic consequences of PD may contribute to an impaired quality of life. The aims of this thesis were to investigate the life situation for people affected by PD in working age, with attention to factors of importance for quality of life and working situation, and to evaluate long-term associations between potential prodromal signs and the later development of PD.Methods: We used a postal survey to investigate the self-perceived life situation among working-aged individuals with PD compared to matched controls, with a specific attention to socioeconomic consequences of disease (paper I). To investigate risk markers preceding the diagnosis of PD (paper II-IV), we used data from nationwide registers. Study II was performed as a cohort study, based on the Swedish Military Service Conscription Register, and study III-IV were performed as nested case-control studies based on a cohort comprising all Swedish citizens aged ≥50 years in 2005.Results: In the survey study (paper I), 38% of the PD participants and 9% of the controls were dissatisfied with life as a whole, and the working situation was an independent risk factor for dissatisfaction with life. In total, 59% of the PD participants had reduced working hours or stopped working due to PD, and many PD participants struggled to cope with their work demands. Support from employer was associated with a higher likelihood to remain employed.We found that low muscle strength in young adulthood, (paper II) and depression (paper III) were associated with an increased risk of PD over follow-up times of more than 2 decades, and that patients with PD were at increased risk of fall-related injuries, hip fractures in particular, a decade or more before the PD diagnosis (paper IV). For depression and fall-related injuries, the association with PD was clearly time-dependent, strongest in the last years before the diagnosis of PD.Conclusions: The results suggest that the prodromal phase of PD may last for more than 2 decades and include also motor symptoms. The consequences of PD include a reduced quality of life associated with the working situation. Employer's support appear to be particularly important for a successful vocational rehabilitation.
Surveillance for emergency events involving hazardous substances--United States, 1990-1992: "Problem/Condition: A review of existing reporting systems indicated that not enough information was being collected to determine the public health consequences of emergency events involving hazardous substances. Reporting Period Covered: January 1990 through December 1992. Description of System: State health departments in selected states collect and each quarter transmit information about the events, substances released, and the public health consequences of hazardous substance releases (i.e., morbidity, mortality, and evacuations) to the Agency for Toxic Substances and Disease Registry (ATSDR). Five state health departments (Colorado, Iowa, Michigan, New Hampshire, and Wisconsin) began data collection on January 1, 1990. On January 1, 1992, the reporting state health departments included those from Colorado, Iowa, New Hampshire, New York, North Carolina, Oregon, Rhode Island, Washington, and Wisconsin. Results and Interpretation: During 1990-1992, 3,125 events were reported from participating states to ATSDR's Hazardous Substances Emergency Events Surveillance (HSEES) system. Of these events, 2,391 (77%) were fixed-facility events (i.e., occurred at stationary facilities), and 723 (23%) were transportation related. In 88% of events, a single chemical was released. The most frequently released hazardous substances were volatile organic compounds (18% of the total 4,034 substances released), herbicides (15%), acids (14%), and ammonias (11%). In 467 events (15% of all events), 1,446 persons were injured; 11 persons died as a result of these injuries. Respiratory irritation (37%) and eye irritation (23%) were the most frequently reported health effects. A total of 457 (15%) events resulted in evacuations; of these, 400 (88%) were ordered by an official (e.g., a police officer or firefighter" - p. 1 ; Dengue surveillance--United States, 1986-1992: "Problem/Condition: Dengue is an acute, mosquito-transmitted viral disease characterized by fever, headache, arthralgia, myalgia, rash, nausea, and vomiting. The worldwide incidence of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) increased from the mid-1970s through 1992. Although dengue is not endemic to the 50 United States, it presents a risk to U.S. residents who visit dengue-endemic areas. Reporting Period Covered: 1986-1992. Description of System: Dengue surveillance in the 50 United States and the U.S. Virgin Islands relies on provider-initiated reports to state health departments. State health departments then submit clinical information and serum samples to CDC for diagnostic confirmation of disease among U.S. residents who become ill during or after travel to dengue-endemic areas and among residents of the U.S. Virgin Islands. In Puerto Rico, an active, laboratory-based surveillance program receives serum specimens from ambulatory and hospitalized patients throughout the island, clinical reports on hospitalized cases, and copies of death certificates that list dengue as a cause of death. Laboratory diagnosis relies on virus isolation or serologic diagnosis of disease (i.e., IgM or IgG antibodies against dengue viruses). Results: In 1986, the first indigenous transmission of dengue in the United States in 6 years occurred in Texas; from the time of that incident through 1992, however, no further endemic transmission was reported. During 1986-1992, CDC processed serum samples from 788 residents of 47 states and the District of Columbia. Among these 788 residents, 157 (20%) cases of dengue were diagnosed serologically or virologically. Of the 157 patients, 71 (45%) had visited Latin America or the Caribbean; 63 (40%), Asia and the Pacific; seven (4%), Africa; and nine (6%), several continents. All four dengue virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4) were isolated from travelers to Asia and the Pacific; however, travelers to the Americas acquired infections with only DEN-1, DEN-2, or DEN-4. Even though the number of laboratory-diagnosed dengue infections among travelers was small, severe and fatal disease was documented. In the U.S. Virgin Islands and Puerto Rico, three serotypes (DEN-1, DEN-2, and DEN-4) circulated during 1986-1992. In Puerto Rico, disease transmission was characterized by a cyclical pattern, with peaks in incidence occurring during months with higher temperatures and humidity (usually from September through November). The highest incidence of laboratory-diagnosed disease (1.2 cases per 1,000 population) occurred among persons < 30 years of age; rates were similar for males and females." - p. 7 ; Surveillance for emergency events involving hazardous substances--United States, 1990-1992 / -- Dengue surveillance--United States, 1986-1992 / JoseÌ? G. Rigau-PeÌ?rez, Duane J. Gubler, A.Vance Vorndam, Gary G. Clark, Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases ; "July 22, 1994." ; Also available via the World Wide Web. ; Includes bibliographical references.
This article is a timely, concise, and unbiased analysis of the national and international responses to the spate of vaping-related lung illnesses and deaths and the epidemic of teen vaping. In view of the recent outbreak of vaping-related lung injuries and deaths in the USA and the epidemic of teen vaping, the viewpoints and recommendations presented in this article have immediate policy implications in the USA and around the world. The perspectives and recommendations are expected to assist medical communities, public health professionals, and regulatory authorities in addressing complex issues related to vaping regulation, which areintertwined with public health, economy, and politics of nations, worldwide.
The objectives of the current study are to define how many and what kind of nosocomial infections are occurring, what are the causative microbes and what kind of drugs can be used in treatment of infection at Al-Hada Armed Forces Hospital, Taif, Saudi Arabia during the year 2004. A prospective study was implemented for all cases admitted at Al-Hada Armed Forces Hospital during the period 1st January, 2004 till 31st December, 2004 and which developed infection. Determination of nosocomial infections was performed using standardized CDC criteria. A total of 1382 patients had developed infection during hospital admission and were included in the study. Of them, 668 (48.3%) had nosocomial infection and 714 (51.7%) had community-acquired infection. Among those who developed nosocomial infections, 216 (32.3%), 172 (25.7%) and 124 (18.6%) had respiratory tract (RTI), urinary tract (UTI) and blood stream infections (BSI) respectively. Surgical site infection (SSI) was reported in 86 cases (12.9%). The overall nosocomial infection rate along the study period was 4.98 per 100 discharged patients. Gram-positive organisms were reported in 31.8%. MRSA (Methicillin-resistant S. aureus) was the commonest (10.2%), followed by coagulase negative staphylococci (8.5%) and MSSA (Methicillin-susceptible S. aureus, 7.4%). While Gram-negative organisms were reported in 66.2%, E. coli was the commonest (22.3%), followed by Pseudomonas aeruginosa (17.6%) and Klebsiella pneumoniae (9.9%). Acinetobacter spp. and MRSA were highly sensitive to Imipenem (88.6%) and Vancomycin (98.5%) respectively. E. coli were highly sensitive to most of the antimicrobial agents except ampicillin (26.6%). Conclusions: Pneumonia, urinary tract infections, and blood stream infections made up the great majority of nosocomial infections. There is a need for further risk assessment associated with main types of infection. ; Die vorliegende Studie hatte zum Ziel, im Al-Hada Armed Forces Hospital (Taif, Saudi Arabien) über den Zeitraum eines Jahres (2004) hinweg ...
Abstract Background Traffic-related injuries are the most common cause of morbidity and mortality of the youth. Our aim was to study epidemiology, risk factors and outcome of hospitalized youth patients injured in road traffic collisions in order to give recommendations for prevention. Methods We prospectively studied all youth (15–24 years) patients having traffic-related injuries who were admitted to Al Ain or Tawam Hospitals, Al Ain City, or who died after arrival to these hospitals during an 18 months period. Demography, location and time of injury, injured body regions, severity, hospital and intensive care unit (ICU) stay and outcome were analyzed. Results Three hundred thirty-three patients having a mean age (SD) of 20 years (2.5) were studied. 87% were males and 72% were UAE nationals. Majority of injured patients were drivers or front-seat passengers (70%), followed by back seat passengers (16%), motorcyclists (5%) and pedestrians (4%). Rollover was the most common crash mechanism (35%), followed by front crash (34%). Twenty seven patients (8%) were ejected during the crash, 14 during roll-over, 7 from quadribikes and three during front crash. 20% of the patients were admitted to the ICU. Median Glasgow Coma Scale was 15 (range 3–15), median Injury Severity Score was 5 (range 1–41), and median total hospital stay was 3 days (range 1–73). Nine (3%) patients died. Conclusions Young UAE-national males are at a higher risk of being injured at traffic. Rollover crash was frequent with high risk of ejection. Promotion of traffic safety and enforcement of safety legislation is necessary.
An Academic Expert Group convened by the Swedish Transport Administration lent its combined experience, expertise and understanding of global road safety issues, problems and solutions to create a set of recommendations for a decade of activity by the public and private sectors that would lead to a reduction of worldwide road deaths by one-half by 2030. The recommendations are made in the context of a Third High-Level Conference on Global Road Safety to be held in Stockholm in February 2020 and are offered for consideration by conference participants and leaders from business, corporations, governments and civil society worldwide. The report reflects on the Decade of Action for Road Safety 2011-2020, addressing both its accomplishments and limitations. The targeted reductions in global road deaths were not achieved, and in fact the number of global road traffic deaths increased over the decade. Available data are insufficient to assess progress on serious injuries. However, there were many foundational accomplishments during the decade, including increased awareness of road safety problems and solutions among governments, corporations, businesses and civil society; measurable and effective safety improvements in many locations; new funding, and new partnerships. Road safety needs were expressed in a new structure using five pillars and evidence-based interventions were identified for each pillar, along with measures and targets. A significant achievement of the Decade of Action 2011-2020 was the inclusion of road safety among the Sustainable Development Goals (SDGs). Integrating a road safety target into SDG 3.6 and 11.2 was a remarkable accomplishment with far-reaching potential. The report proposes a vision for the evolution of road safety and recommends a new target of 50 percent reduction in road deaths and serious injuries by 2030 based on expanded application of the five pillars, adoption of Safe System principles and integration of road safety among the Sustainable Development Goals. The vision describes an evolution of road safety, building from the foundation of the pillars, incorporating adoption of the Safe System approach, and leading to a future comprehensive integration of road safety activity in policy-making and the daily operations of governments, businesses, and corporations through their entire value chains. The vision also stresses the need for further engagement of the public and private sectors and civil society in road safety activities and capacity-building among road safety professionals worldwide.
BackgroundBone stress fractures are overuse injuries commonly encountered in sports and military medicine. Some fatigue fractures lead to morbidity and loss of active, physically-demanding training days. We evaluated the incidence, anatomical location, risk factors, and preventive measures for fatigue fractures in young Finnish male conscripts.MethodsFive cohorts of 1000 men performing military service, classified according to birth year (1969, 1974, 1979, 1984, 1989), were analysed. Each conscript was followed for his full military service period (180days for conscripts with rank and file duties, 270days for those with special training, 362days for officers and highly trained conscripts). Data, including physical activity level, were collected from a standard pre-information questionnaire and from the garrisons' healthcare centre medical reports. Risk factor analysis included the conscripts' service class (A, B), length of military service, age, height, weight, body mass index, smoking, education, previous diseases, injuries, and subjective symptoms, as well as self-reports of physical activity before entering the service using a standard military questionnaire.ResultsFatigue fractures occurred in 44 (1.1%) of 4029 men, with an incidence of 1.27 (95% confidence interval: 0.92-1.70) per 1000 follow-up months, and mostly (33/44, 75%) occurred at the tibial shaft or metatarsals. Three patients experienced two simultaneous stress fractures in different bones. Most fatigue fractures occurred in the first 3months of military service. Conscripts with fatigue fractures lost a total of 1359 (range 10-77) active military training days due to exemptions from duty. Conscripts reporting regular (>2 times/week) physical activity before entering the military had significantly fewer (p=0.017) fatigue fractures. Regular physical activity before entering the service was the only strong explanatory, protective factor in the model [IRR=0.41 (95% CI: 0.20 to 0.85)]. The other measured parameters did not contribute significantly to the incidence of stress fractures.ConclusionRegular and recurrent high-intensity physical activity before entering military service seems to be an important preventive measure against developing fatigue fractures. Fatigue fractures should be considered in conscripts seeking medical advice for complaints of musculoskeletal pain, and taken into consideration in planning military and other physical training programs. ; Peer reviewed
Background: Two separate but complementary epidemiologic surveillance methods for human stampedes have emerged since the publication of the topic in 2009. The objective of this study is to estimate the degree of underreporting in India. Method: The Ngai Search Method was compared to the Roy Search Method for human stampede events occurring in India between 2001 and 2010. Results: A total of 40 stampedes were identified by both search methods. Using the Ngai method, 34 human stampedes were identified. Using a previously defined stampede scale: 2 events were class I, 21 events were class II, 8 events were class III, and 3 events were class IV. The median deaths were 5.5 per event and median injuries were 13.5 per event. Using the Roy method, 27 events were identified, including 9 events that were not identified by the Ngai method. After excluding events based on exclusion criteria, six additional events identified by the Roy's method had a median of 4 deaths and 30 injuries. In multivariate analysis using the Ngai method, religious (6.52, 95%CI 1.73-24.66, p=0.006) and political (277.09, 95%CI 5.12-15,001.96, p=0.006) events had higher relative number of deaths. Conclusion: Many causes accounting for the global increase in human stampede events can only be elucidated through systematic epidemiological investigation. Focusing on a country with a high recurrence of human stampedes, we compare two independent methods of data abstraction in an effort to improve the existing database and to identify pertinent risk factors. We concluded that our previous publication underestimated stampede events in India by approximately 18% and an international standardized database to systematically record occurrence of human stampedes is needed to facilitate understanding of the epidemiology of human stampedes.
Introduction Rabies is a vaccine preventable disease caused by the rabies virus. Since emergency physicians are the first point of contact with individuals who have suffered an animal-bite/scratch, knowledge of rabies, its prevention strategies and PEP recommendations is of paramount importance in them. Objectives To find out the knowledge regarding post exposure management of rabies and estimate the associationbetween socio-demographic factors and knowledge regarding rabiesamong emergency physicians working at NBMCH. Materials and Methods An institution based observational study with a cross-sectional design was carried out between March and May 2018, among 111 junior doctors who had worked in the emergency department at NBMC&H in the previous 1 year. Individual questions and cumulative scores to assess knowledge were compared using SPSS. Results The mean age of the participants was 25.75±3.26 years, with most of the participants being male (73%). Most participants knew about the epidemiology and categorisations of wounds,knowledge of the post-exposure management and prophylaxis with rabies immunoglobulin and ARV varied. One fourth (26.1%) did not know about the requirement to wash the wound in running water for 15 minutes.About half of the participants (55.0%) did not know the intradermal dosage regimen of the rabies vaccine, and almost a third also did not know the dosage regimen for re-exposure. A third of the participants had insufficient knowledge based on the cumulative scores. Designation of the physicians was significantly associated with sufficiency of knowledge regarding PE management of rabies. It was seen that physicians who had recently completed their undergraduate degrees and were posted as interns had the least knowledge (50.0%) of post-exposure management of rabies as compared to post-graduate physicians and house-staff. Conclusion Inadequate knowledge of healthcare personnel, as estimated from the current study, can endanger the life of the patients attending the centres for treatment and increase the healthcare budget of the government on unnecessary vaccines and immunoglobulins on the other.
Background: According to the World Health Organization (WHO), Traumatic Brain Injury (TBI) will become the third largest cause of global disease by the year 2020. Despite its astonishing numbers, TBI remains a silent or even forgotten epidemic with significant paucity in epidemiological data. TBI in developing countries represents a disproportionate burden of disease and data are lacking regarding the unique demographics in South Africa to design and implement focused prevention programmes. A valuable tool to assess the severity of TBI is the use of Computer tomography (CT). CT also is the main imaging modality to provide rapid identification and information for the management of children with TBI. CT scanning utilises ionising radiation and as an imaging modality poses risk to the patient. In order to guide decision protocol/algorithm, various Clinical Decision Rules (CDRs) have been established in High Income Countries. These protocols, including the need for CT scan might differ in a Medium/Low Income setting. Methodology: This is a prospective, single centre cohort study. Data were collected over an 18-month period (1 August 2015 - 31 January 2017). Children under the age of 13 years (n=3007) presenting to RCWCH after sustaining a head injury were included. Various epidemiological data were collected. A Road Safety Questionnaire was also used to evaluate safety knowledge of health care workers. Three different CDRs were compared to the standard of practice in RCWCH. A final analysis of demographics, mechanism of injury, radiology outcome, safety analysis and evaluation of a comparison of local protocol compared to the other CDRs was performed using descriptive statistics. Results: The mean age of paediatric patients presenting after a head injury was 4.6 years. There was a significant male predominance (66%) and almost two thirds of all children were of pre-school age. Falls (53%; n=1601) represented the most common mechanism of injury across all age groups, followed by road traffic related injuries (RTI) (29%; n=864), struck by or against an object (9%; n=279) and injuries as a result of interpersonal violence (8%; n=230). Within the subset of RTI (n=864) only 6 passengers were appropriately restrained, with 142 unrestrained and 56 passengers transported on the back of a goods vehicle. In the under 3-yearold age group, only 1 patient was appropriately transported in a car seat, with 51 unrestrained and 6 transported on the back of a goods vehicle. Pedestrian related injuries were by far the largest group of RTI (70%) with 50% of these under the age of 5 years. Intentional injuries inflicted by an adult were most common (34%) in the pre-verbal (under 2 years old) group. Interpersonal violence among minors (assault with a brick or stone) constituted 52% of intentional injuries. Eight firearm related injuries were recorded. Appliances and iron gates that were not correctly installed were additional causes of injury. CT scans were obtained according to the RCWCH protocol in 59% of cases and 34% showed an abnormal result. The sensitivity (98%) and specificity (93%) while using the standard of practice protocol was better than the 3 CDRs developed in High Income Countries. Analysing our Road Safety Questionnaire there appears great room for improvement regarding awareness of road safety guidelines and legislation. Conclusion: The performance of the current RCWCH CT scan protocol appears appropriate in our setting although there is some room for improvement using the strengths of the other CDRs. Valuable insight regarding the epidemiology of TBI in our setting has been highlighted. Of specific importance is the large proportion of very young children at risk of injury by all mechanisms of injury, particularly pedestrian-related injuries, unrestrained passengers and interpersonal violence among minors. Important gaps in knowledge about current recommendations for road safety were identified by the questionnaire. As long as these issues are not appropriately addressed through enhanced injury prevention programmes, children will continue to carry the heavy burden of TBI morbidity and mortality.
Background: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders. Methods: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach. Findings: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable). Interpretation: Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies. Funding: Bill & Melinda Gates Foundation.
INTRODUCTION: The European badger (Meles meles) is a known wildlife reservoir for bovine tuberculosis (bTB) and a better understanding of the epidemiology of bTB in this wildlife species is required for disease control in both wild and farmed animals. Flow infusion electrospray—high-resolution mass spectrometry (FIE-HRMS) may potentially identify novel metabolite biomarkers based on which new, rapid, and sensitive point of care tests for bTB infection could be developed. OBJECTIVES: In this foundational study, we engaged on assessing the baseline metabolomic variation in the non-bTB infected badger population ("metabotyping") across Wales. METHODS: FIE-HRMS was applied on thoracic fluid samples obtained by post-mortem of bTB negative badgers (n = 285) which were part of the Welsh Government 'All Wales Badger Found Dead' study. RESULTS: Using principal component analysis and partial least squares—discriminant analyses, the major sources of variation were linked to sex, and to a much lesser extent age, as indicated by tooth wear. Within the female population, variation was seen between lactating and non-lactating individuals. No significant variation linked to the presence of bite wounds, obvious lymphatic lesions or geographical region of origin was observed. CONCLUSION: Future metabolomic work when making comparisons between bTB infected and non-infected badger samples will only need be sex-matched and could focus on males only, to avoid lactation bias. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11306-022-01888-6.
Frontmatter -- Contents -- Introduction The Health Consequences of War -- Part I Afghanistan and Pakistan -- 1 Childbirth in the Context of Conflict in Afghanistan -- 2 Drone Strikes and Vaccination Campaigns How the War on Terror Helps Sustain Polio in Afghanistan and Pakistan -- 3 Remaining Undone Heroin in the Time of Serial War -- 4 Dignity under Extreme Duress The Moral and Emotional Landscape of Local Humanitarian Workers in the Afghan- Pakistan Border Areas -- Part II Iraq -- 5 War and the Public Health Disaster in Iraq -- 6 The Political Capital of War Wounds -- 7 Iraqis' Cancer Itineraries War, Medical Travel, and Therapeutic Geographies -- 8 War and Its Consequences for Cancer Trends and Services in Iraq -- Part III United States -- 9 Imagining Military Suicide -- 10 Afterwar Work for Life -- 11 "It's Not Okay" War's Toll on Health Brought Home to Communities and Environments -- Appendix The Body Count -- About the Editors -- About the Contributors -- Index
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