The Medical clinics of North America
-
Population migration plays a critical role in the spread of disease by initiating outbreaks of acute diseases, changing the prevalence of infectious diseases at a given location, and changing the face of chronic disease resulting from previous infection. This article focuses on the recent demographic changes in North America that have facilitated the introduction and spread of new microbial threats, the role migrant populations play in changing the demographics of specific infectious diseases, and the potential responses of clinicians and public health officials in addressing the challenges posed by these infections. The emphasis of the article is on immigrant and migrant populations entering North America; the role of travelers in emerging infectious diseases is addressed in another article in this issue.
-
Med. Clin. North Am. · Nov 2008
ReviewThe role of the traveler in emerging infections and magnitude of travel.
Travel and trade have grown immensely. Travelers interact with people and microbes during their journeys, and can introduce infectious agents to new areas and populations. Studying illnesses in travelers is a source of knowledge into diseases of resource-poor regions and the control of these diseases. Travel-associated illnesses also serve to detect emerging infections.
-
Searches of the literature or Internet using the term "medical tourism" produce two sets of articles: travel for the purpose of delivering health care or travel for the purpose of seeking health care. The first usage primarily appears in the medical literature and is beyond the scope of this article, which focuses on travel to seek health care. Still, there are some aspects these two topics have in common: both are affected by ease and speed of international travel and communication associated with globalization, and both raise questions about continuity of care as well as issues related to cultural, language, and legal differences; both also raise questions about ethics. This article describes some of the motivating factors, contributing elements, and challenges in elucidating trends, as well as implications for clinicians who provide pretravel advice and those who care for ill returning travelers.
-
Med. Clin. North Am. · Jul 2008
ReviewLiver transplantation: indications, pretransplant evaluation, surgery, and posttransplant complications.
Liver transplantation is the therapeutic option of choice for acute and chronic end-stage liver disease. The indications and contraindications to liver transplantation have become established, as has the operative and postoperative management. This article provides a practical clinical approach to the evaluation and management of patients with acute and chronic liver failure, with particular emphasis on liver transplant recipient selection, clinical management, and complications. The goal is to provide helpful guidelines to caregivers involved in the multidisciplinary care of these complex patients.