From the President of the American Society of Addiction Medicine Recent Developments in Alcoholism (Volume 10) is a major contribution to the literature of addiction medicine. This volume, 'ru.cohol and Cocaine: Similarities and Differences," contains an impressive collection of chapters from the basic research, epidemiological, and clinical research perspectives, as well as articles that address the relative policy issues and clinical application and patient care concerns. It also sends a message to those who would still distinguish between alcohol and drugs, or legal and illegal drugs. In the research laboratory, in the intentions and behavior of the user, and by the clinician, such distinctions have never been upheld. The first section, "Clinical Pathology," includes chapters on the role of alcohol in cocaine dependence, dual-diagnosis empirical and developmental humanistic approaches, and on neuroendocrine and catecholamine levels in humans during administration and withdrawal of cocaine and alcohol, emer gency room evaluation of cocaine-associated neuropsychiatric disorders, and clinical and pharmacological interactions of alcohol and cocaine. These chap ters, written by authors who are preeminent in their fields, offer a broad perspective to both the researcher and the clinician on relevant issues in clinical pathology. .

The incidence of insulin-dependent diabetes mellitus (100M) varies dramatically across racial groups and countries, with annual age-adjusted rates of approximately 40/100,000 per year in Finland, but only 0.51100,000 per year in China. Although reasons for these marked geographic differences are unknown, it is likely that genetic variations across populations play a m or role. To determine the contribution of genetic factors to the global patterns of 100M incidence, international comparative studies are now being undertaken as part of the WHO Multinational Project for Childhood Oiabetes, known as the DIAMOND Project. It is, therefore, necessary to develop and implement epidemiologic standards for these investigations which can be applied across populations. This will ensure that comparable data are obtained in all countries, and that relevant scientific questions can be properly addressed. The development of standards for molecular epidemiologic studies of 100M is the of the NATO Advanced Research Workshop. During this meeting at the objective University of Pittsburgh, scientists from across the world convened to discuss issues relating to the standardization of: 1. the collection of family history data to assess the risk of 100M in first degree relatives, 2. case-control molecular epidemiology studies of 100M susceptibility, 3. HLA family studies, 4. laboratory methods and ONA technology transfer for genetic marker evaluations.

The book presents a basic introduction to epidemiology from the perspective of economics, using economic modeling to better understand and describe how infectious disease spreads. Three main elements are introduced: epidemiology, social network analysis, and the economics needed to model the behavior of individuals in the presence of infectious disease. The book aims to provide a starting point for discussion between medical professionals, social scientists and public health officials, the three groups interested in the spread of disease.

This book attempts to set communicable diseases and the efforts to control them in a social and historical context. The primary focus is on England with its particular history, culture and traditions. The timescale covered is extensive and ambitious, and the many strands that came together in the nineteenth century to form the English public health service are clearly highlighted. However the main emphasis of the narrative is on developments from the Second World War onwards, in some of which the author has had a degree of personal involvement as a schoolchild, medical student, hospital doctor, Army doctor and public health physician. The work as a whole reveals the persisting nature of communicable diseases throughout history and strongly argues that, although the relevant importance of individual infections may vary over time, man's struggle against the microbiological world can never be relaxed. How England has been affected is described in detail and evidence is put forward to suggest that complacency (or at least misjudgement) concerning the ever-present risks of emerging and re-emerging infections, led unwisely to the dismantling in 1974 of its established arrangements for their control, along with the subsequent need, frequently repeated, to create new structures for this purpose. This book will appeal strongly to all students and practitioners of public health along with those interested in English social history.

Throughout the world, scientists and the general with environmental illness. Part II presents an over public are concerned about the adverse effects of view of chemical and physical agents commonly toxic agents found in contaminated air, water, food, found in contaminated air, water, food, and soil. and soil. In the past, attention has focused on haz The problem of hazardous wastes is also discussed. ards originating in the workplace. As a consequence, Part III characterizes the body's defense against occupational medicine has become a well-recognized such exposure. Defenses at the portals of entry are and established clinical discipline. Much less atten discussed, with emphasis placed on the role of tion has been paid to nonoccupational hazards. There nutrition. Detoxication and immunologic defense is a growing awareness, however, of the dangers of mechanisms are described. Part IV indicates the exposure to toxic chemical and physical agents in importance of and provides instruction on the the homes, community, and general environment, method of including occupational and environmen especially for the fetus, the infant, the very young, tal factors in the routine medical history. The role of the elderly, and the chronically ill, those most sus enhanced susceptibility as a factor in an individual's ceptible. Environmental medicine, fOCUSing on the response to toxic exposure is discussed."

This volume is intended for the professional who is a newcomer to the area of environmental radon. It marks the first time that chapters on these subjects have been brought together in a single volume, and it is arranged so that anyone with some basic university-level chemistry and physics can develop a clear understanding of the different aspects involved. The volume is intended to serve as a supplementary textbook in public health, environmental, and health physics courses. It also can be used by the professional to get "up to speed" in this rapidly evolving field. The chapters are not necessarily a discussion of the latest research in this fast-moving field, but are intended to bring the reader to a level at which he can easily understand the current literature. At the back of this volume the reader will find the references for the individual chapters, a general list of reading materials, a glossary, an appendix describing the equations for radioactive decay for a series of progeny, a table of often used conversion factors, and the addresses and brief biographies of the authors and editors. Both historical and SI (International System) units are used throughout the book to provide information for the widest range of readers. Thanks go to Tom Hess for the idea for this volume and to Jessica Barron for help in editing.

Here is the first comprehensive cross-disciplinary work to examine the current health situation of our immigrants, successfully integrating the vast literature of diverse fields -- epidemiology, health services research, anthropology, law, medicine, social work, health promotion, and bioethics -- to explore the richness and diversity of the immigrant population from a culturally-sensitive perspective. This unequalled resource examines methodological issues, issues in clinical care and research, health and disease in specific immigrant populations, patterns of specific diseases in immigrant groups in the US, and conclusive insight towards the future. Complete with 73 illustrations, this singular book is the blueprint for where we must go in the future.

The intestinal protozoan Giardia was first described over 300 years ago in 1681 by Leeuwenhoek, from his own stools. In his description of Giardia, he noted the size, movement, and morphology of the organism, and associated its presence with the diarrheic nature of his stools and his dietary habits. This truly remarkable account contains the first description of Giardia in morphologic, pathogenic, and epidemiologic terms. Our knowledge of the organisms in the genus Giardia has advanced tremendously in the past two decades. With the advent of new tech nologies, including techniques in electron microscopy, biochemistry, immunochemistry, tissue culture, and physiology, a tidal wave of information has appeared on the organization and function of this parasitic protozoan and its interaction with its host. The purpose of this book is to celebrate the tricentennial discovery of Giardia by Leeuwenhoek by presenting the above-mentioned advances in our knowledge of Giardia and giardiasis. In the first section of this book, the dominant theme is the biology of the organism and the correlation of structure-function relationships."

The disorders induced by iodine deficiency affect at least one billion people. Because ofits effects on brain development, iodinedeficiency is the single most preventable cause of mental retardation in the world. Therefore, the United Nations and the Heads of State of almost all the world's countries represented at the Summit for Children in 1990 adopted resolutions to eradicate the disorders induced by iodine deficiency (IDD) by the year 2000. For geological and socio-economic reasons, most of the populations affected by iodine deficiency disorders live in isolated and usually mountainous areas, in pre industrialized parts ofthe world. The problem of iodine deficiency in Europe has been greatly underestimated in the last decades. After the remarkable studies on the effects of iodine deficiency and their prevention and correction in Switzerland, IDD was generally considered no longer a significant public health problem in Europe. However, surveys carried out in the early 1980's under the auspices of the European Thyroid Association, clearly demonstrated the persistence of moderately or even severely affected areas. These surveys also highlighted the lack ofinformation about large parts ofEurope, especially its eastern part. It is only quite recently, following major changes in international relations and thanks to the support of UNICEF, WHO, the International Council for the Control of Iodine Deficiency Disorders and the European Thyroid Association, that more extensive surveys have been conducted in several parts of Europe hitherto almost unexplored. These surveys showed that most European countries were iodine deficient."

In this groundbreaking work, distinguished contributors explore the myriad relationships between networks of social support and the development, treatment, and rehabilitation of individuals with cardiovascular disease. Chapters span the range from conceptual to methodological issues, and take into account gender, environmental, and cultural differences. The book will provide a wealth of information for clinicians and students in the fields of behavioral medicine, psychophysiology, and cardiovascular disease.

Oscar Harkavy offers a unique insider's view of the fascinating world of population politics. Chapters trace the growth of the movement as well as the various foundations, governments, and intergovernmental organizations which were an integral part of it from its beginning in the 1950s, through its growth during the 60s and 70s, to the present. Topics include the role of social science in understanding the causes and effects of population growth; reproductive research and contraceptive development; and the politics of family planning, sex education, and abortion in the United States.

Responding to the Homeless: Policy and Practice is largely a product of a unique collaboration between Russell K. Schutt and Gerald R. Garrett and their Boston community. As such, it offers a rich perspective on the problem of homelessness that is derived from the authors' shared experience with researchers, academics, students, providers, policymakers, and homeless persons themselves. Schutt and Garrett take the reader into the shelters and acquaint him or her with the philosophical and practical dilemmas facing line workers as well as policymakers. They also take the reader into the community to better understand the housing market and the dysfunctional continuities among shelter, housing, treatment, and social supports. There are sensitive discussions of the salient health problems that too commonly touch the lives of homeless individuals, such as substance abuse and AIDS. The volume also includes clear descriptions of the sometimes elusive processes of counseling and case management for homeless individuals. The sidebars of "what to do" and "what not to do" contain useful information that will both inform and empower individuals who are working on the front lines, and inspire and prepare future caregivers. While the eminently readable organization and style of the book are sugges tive of a highly practical handbook on the basics of homelessness, the authors and their contributors have also produced a scholarly volume that is replete with current research findings, programs descriptions, case studies, and vignettes."

Public health has a legacy of neglect regarding social and behavioral research. Too often, prompted by technical and scientific progress, we have ignored even marginalized-the vital "human element" in health thinking and prac tice. Thus, for example, while family planning programs focused on providing a choice among safe and effective contraceptive methods (a supremely worthy goal), the central issue of sexuality and sexual behavior was generally neglected. Similarly, the enormous and important efforts to develop rapid and reliable diagnostic and treatment methods for sexually transmitted diseases helped divert attention away from the crucial issues of sexual practice. In short, we seem to have difficulty addressing the fundamental behaviors-including sex, drug taking and other intoxications, and violence-that are central to the major causes of preventable morbidity, disability, and premature mortality in the world today. Our collective reluctance to examine and understand ourselves is also expressed in the oft-repeated pipedream that scientific progress will "take care of" the HIV / AIDS pandemic by delivering a preventive vaccine, an effective cure, or both. Yet even a cursory glance at the relationship between scientific/ technical progress and health shows that meeting the scientific challenges is only one step toward effective application of the vaccine or drug. It is typical, not atypical, that hepatitis B vaccine is only now becoming relatively freely available to large populations in the developing world, more than a decade after the vaccine's licensure.

If resources for HIV prevention efforts were truly unlimited, then this book would be en tirely unnecessary. In a world with limitless support for HIV prevention activities, one would simply implement all effective (or potentially effective) programs without regard to expense. We would do everything useful to prevent the further spread of the virus that has already claimed hundreds of thousands of lives in the United States and millions of lives worldwide. Unfortunately, funding for HIV prevention programs is limited. Even though the amount of available funding may seem quite large (especially in the United States), it is still fixed and not sufficient to meet all needs for such programs. This was very well illustrated in the summer of 1997 when over 500 community-based organizations applied for a combined total of $18 million of HIV prevention funding from the U.S. Centers for Disease Control and Prevention (CDC). Less than one-fifth ofthese organizations received support via this funding mechanism. Hence, although $18 million may seem like a large amount of money at first blush, it is not enough to meet all of the prevention needs that could be addressed by these community-based organizations.

This book is a summary of the presentations and discussions at the Workshop on Methods of Pesticide Exposure Assessment held in Ottawa, Canada, on October 5-8, 1993. The event was a joint effort of Health Canada and the North Atlantic Treaty Organisation and was officially supported by the United States Environmental Agency and the Organisation for Economic Co-operation and Development (OECD). The goal of the workshop was to examine current issues in the field of pesticide exposure assessment with the aim of reaching an internationally harmonized approach to methods of exposure assessment. With regulatory agencies of OECD Member countries moving towards the harmonization of data requirements, it was timely and beneficial to bring together international experts in the field of pesticide exposure assessment to discuss current issues. Approximately 60 delegates and 20 observers participated, including individuals from 15 different countries representing academia, government, industry and international organizations. A guidance document on methods of pesticide exposure assessment was presented as a means to achieving the goal of international for critique and discussion harmonization. After extensive discussion, the workshop delegates agreed in principle to procedures for revising the guidance document. Following revision and further review by a designated peer review group, the revised document will be submitted to the OECD for consideration as a draft OECD Guidance Document on pesticide exposure assessment methods. Both the revised and original documents are included in these proceedings.

Reproductive tract infections (RTis) have become a silent epidemic that is devastating women's lives. Each year, thousands of women die needlessly from the consequences of these infections, including cervical cancer, ectopic pregnancy, acute and chronic infections of the uterus and the fallopian tubes, and puerperal infections. For many women, this happens because they receive medical attention too late, if at all. The terrible irony of this tragedy is that early diagnosis of and treatment for many RTis do not require high-technology health care. For the hundreds of millions of women with chronic RTis acquired from their sexual partners, life can become a living hell. Infection is a major cause of infertility, and it leads to scorn and rejection in many countries. These women may experience constant pain, have festering lesions of the genital tract, be at enhanced risk of second ary diseases, and endure social ostracism. The problems associated with RT s have grown even greater in the past decade with the emergence of human immunodeficiency virus (HIV) and AIDS. Preexisting sexually transmitted disease, particularly when associated with genital tract ulcers, raises women's vulnerability to the transmission of HIV 3-5 fold."

Research on cholera has contributed both to knowledge of the epidemic in particular, and to a broader understanding of the fundamental ways in which cells communicate with each other. This volume presents current knowledge in historical perspective to enable the practitioner to treat cholera in a more effective manner, and to provide a comprehensive review for the researcher.

In recent years, a great deal of interest has been focused on suicide in the elderly and in the young. However, in line with modem trends in psychology, sociology, psychiatry, anthropology, and other human health fields, interest has now shifted to suicide across the life span, from childhood through adulthood to old age. This book has been conceptualized within this developing tradition. There are various ways in which life's timelines can be conceptualized. Developmental theory, we believe, should be open-ended. This has widened-and will continue to widen-our understanding of many complicated human acts including suicide. Though suicide is in many ways the same across the entire life span, understanding the time-lines in the suicidal process is imperative. To do so, however, is, we believe, challenging. In this volume, we attempt to engage in the process of understanding suicide from a developmental perspective. To do this, we have been fortunate to obtain the cooperation of a highly competent group of contributors. One interesting footnote to our list of authorities is that they represent suicidologists from across the life span-a few who are at the beginning of their careers, a large number in their middle years, and a few who are in the Indian summer of their professional lives.

This book is intended as a relatively nontechnica1 introduction to eurrent demographie methods. It has been several years in preparation, beginning from occasional class handouts I wrote to elaborate on essential points of demographie methodology. Its growth from scattered notes to an integrated text was a natural process, if a gradual one. The eontent of the book addresses three objectives. first, I have tried to avoid demographie methods that are now dated. In some ehapters, that has meant eoncentrating on formulas most demographers recognize. In the ehap ters on life tables, it meant testing competing formulas on a variety of real and synthetie data se.ts, and dropping or relegating to footnotes those that were least accurate. Second, I have attempted to give readers a sense of the limits of different formulas and methods. I am a terse writer, however, and for the reader that means most sentences carry weight. Chapters should be read attentively, with careful regard to commentary as weIl as to formulas and examples. Finally, I have tried to make the principal methodologies of the book accessible, by offering explanations for formulas that are not obvious, by keeping examples to the forefront, and by placing relatively specialized topics in ehapter appendices.

From the President of the Research Society on Alcoholism In recent years, increasingly convincing evidence in support of a biobehavioral conceptual model of the etiology of alcoholism has emerged. In this model, the disorder is perceived as arising from the interaction of geneticlbiological vulnerability and psychosocial risk. Drinking, or alcohol-seeking, is a metric trait. Alcoholism, which is a state of abnormally intense alcohol-seeking be havior that, over time, leads to the alcohol dependence syndrome, lies at the extreme, high end of this quantitative measure. Metric traits are influenced by multiple genes; the extent of genetic loading of biological risk for alcoholism would be different in different individuals. Added to this kind of variability is the wide range of options for exposure to the psychosocial risk factors of heavy drinking provided by modern society. Further, environmental prov ocation also changes when life events change. It is not surprising, therefore, from the combination of the kinds of genetic and environmental variability described above that there is a wide array of patterns of expression of the disorder alcoholism, referred to by some as "alcoholisms. " In the search for understanding of underlying mechanisms and rational bases for potential therapy, it is important to focus our attention on the final common pathway of this disorder, alcohol-seeking behavior. This series, ever since its beginning in 1983, has been sensitive to the complexities of the interaction between biological and psychosocial risk factors in alcoholism.

Psychological vulnerabilities and environment influences are the most powerful forces shaping the behavior and choices of students to use harmful substances. This book employs computer-assisted Associative Group Analysis technology of comparative imaging and cognitive mapping to identify these factors and offers new perspectives for more comprehensive risk assessments and effective prevention.

The 1989 Annual Meeting of the Society for Risk Analysis dramatically demonstrated one of the most important reasons for having the Society - to bring together people with highly diverse backgrounds and disciplines to assess the common problems of societal and individual risks. The physical scientists emphasized the analytical tools for assessing environmental effects and for modeling risks from engineered systems and other human activities. The health scientists presented numerous methods of analyzing health effects, including the subject of dose-response relationships, especially at low exposure levels - never an easy analysis. The social and political scientists concentrated on issues of risk perception, communication, acceptability, and human touch. Others discussed such issues as cost-benefit analysis and the risk-based approach to decision analysis. Use of risk assessment methods for risk management continued to be a matter of strong opinion and debate. The impacts of state and federal regulations, existing and planned, were assessed in sessions and in luncheon speeches. These impacts show that risk analysis practitioners will have an increasingly important role in the future. They will be challenged to provide clear, easily understood evaluations of risk that are responsive to society's concern for risk, as evidenced in laws and regulations. Of course, the various risk analysis specialties overlapped in domains of interest.

This volume of the series Advances in Risk Analysis consists of papers presented at the 1988 Annual Meeting of the Society for Risk Analysis, which was held October 30 through November 2 at the Mayflower Hotel in Washington, DC. The papers span the gamut of the increasing number of risk assessment topics addressed by the Society since it held its fIrst annual meeting in June 1981, also in Washington DC. Organized to promote interdisciplinary analyses, the Society approaches risks from three broad perspectives: (1) the impact of various risks on the health of the world's populations and on the environment; (2) the social and political implications of specifIc risks, and (3) the management and reduction of risks through the development of a risk analysis methodology and corresponding data bases. The papers included in this volume typify these three approaches and illustrate their interdependence. For example, both cancer and noncancer health risks are examined for a variety of situations that exist within society. The public's perception of risks and the correlation between that perception and the acceptance or nonacceptance of certain risks is also addressed. In addition, the progress to date on predicting and quantifying specifIc risks, including the risks associated with the construction and use of large engineered systems, is reported. Included among the papers are several dealing with recent current issues, such as the impact of California's Proposition 65, hazardous waste disposal, and chemical accidents.

Proceedings of the FEMS Symposium on Genes and Proteins Underlying Microbial Urinary Tract Virulence: Basic Aspects and Applications, held September 16-19, 1999, in Pecs, Hungary. Urinary tract infections are among the most frequent diseases caused by microbial pathogens. In this volume, researchers, clinical microbiologists and clinicians exchange the latest ideas covering four major aspects of this important topic: * Genetic information, synthesis and assembly of virulence factors in urinary pathogens; * Regulation of genes involved in the phenotypic appearance of virulence; * Host-parasite interactions determining the process and outcome of the infection; * Possible applications of the above aspects in diagnosis, therapy and prevention.

This book has been well received in many places and in many countries. It was awarded a ranking in the top ten publications on behavioral medicine in the year that it first appeared. When, in 1977, we began to fit the components of Cancer, Stress, and Death together, the established medical view was that each subject repre sented a different discipline, and that to integrate fields so diverse in information content was to seek to achieve a synthesis beyond reasonable limits. Had we been required to concern ourselves with the knowledge of each component in its entirety, this might have been so, but our concern, of course, was to integrate only those items of knowledge in any one field that could bear upon the field of interest of another. Moreover, we were concerned that physi cians and scientists take account of the inner forces that shape motivation and individual behavior, as well as the cultural identity of individuals, and we hoped that the biopsychosocial way in which we believed would gain ground and win support. Now, with need for a second edition, one can hardly conceive of not bringing together diverse contributions in one volume. Such syntheses as we have made clearly confirm that one can arrive at several levels of understanding of human situations through wise integration of biological paradigms within various social, cultural, and psychological parameters-which essentially is a simple way of defining the biopsychosocial way."