Paul Jung

Fatalities in the Peace Corps: A Retrospective Study, 1984 to 2003

BACKGROUND To determine causes of death for Peace Corps Volunteers (PCV) between 1984 and 2003 and compare them with prior Volunteer death rates and with US death rates. METHODS We conducted a retrospective cohort study of all PCV between 1984 and 2003 and compared them to published data for prior years and against US death rates. RESULTS Of the 66 deaths in our study period, the major causes were unintentional injury, homicide, medical illness, and suicide. Comparisons to US mortality data controlled for age, marital status, and educational attainment found equal or lower death rates among Volunteers. When compared to previous study results from 1961 to 1983, the total number of deaths, as well as the death rate per Volunteer-year, decreased. Deaths from unintentional injury, suicide, and medical illness decreased in number and rate; only homicides increased in number during our study period, but this increase did not reach statistical significance. CONCLUSIONS PCV are exposed to unique risks, but these risks have become significantly less fatal over the past 20 years when compared to prior Peace Corps data and matched US population data.

Preventive Medicine’s Identity Crisis

What is preventive medicine? Specifically, what is the specialty of preventive medicine, and how should it best be described? The specialty of preventive medicine is poorly understood, not only by the medical profession and the general public, but even among some of its practitioners. Currently, there is no unifying, vernacular explanation of the specialty of preventive medicine, to its detriment. This paper presents the argument that preventive medicine is the medical specialty for public health, which should be the preferred identity for the specialty. The American Board of Preventive Medicine defines preventive medicine as “the specialty of medical practice that focuses on the health of individuals, communities, and defined populations.” The Board further separates its specialty into three categories “that emphasize different populations, environments, or practice settings: aerospace medicine, occupational medicine, and public health and general preventive medicine.” For the purposes of this paper, preventive medicine refers to the latter category, as the authors believe aerospace and occupational medicine are more naturally defined and do not suffer from the same identity crisis as general preventive medicine. Preventive medicine’s identity has been argued for many years among practitioners of the specialty, but not necessarily in the pages of this or any other journal. A review of the medical literature found no published articles in the past 35 years specifically addressing the best way to convey the specialty of preventive medicine in the U.S. Although published articles argue the need for public health physicians generally or preventive medicine physicians specifically, no articles have argued that preventive medicine should be advertised as the specialty of public health. Interestingly, the Accreditation Council for Graduate Medical Education lists preventive medicine as a “hospital-based specialty,” indicating that even the medical establishment does not have an appropriate context for categorizing the specialty. The mission statement of the American College of Preventive Medicine does not mention “public health.” The American Board of Preventive Medicine does not use the term “public health” in its explanation, noting instead that “Public Health and General Preventive Medicine” is one of its specialty areas, implying a distinct difference between public health and preventive medicine, when instead the two should be indistinguishable. Given the lack of systematic evidence on the definition of the specialty, the authors believe it would strongly benefit those practicing the specialty to engage in promoting a “brand” of the specialty for the benefit of the field, and that “brand” should be public health.

Dengue in Peace Corps Volunteers, 2000–14

BACKGROUND Dengue is an arboviral disease estimated to cause 50-100 million infections each year in >100 tropical and subtropical countries. Urbanization, human population growth and expanded global travel have resulted in an increase in the incidence of dengue worldwide. International travellers to areas with endemic dengue are at risk of contracting dengue and US Peace Corps Volunteers are one specific group of long-term travellers who are exposed to environments where dengue can be contracted. METHODS Cases of dengue among Peace Corps Volunteers, defined as clinically apparent infections with laboratory-confirmation by a positive NS1 antigen test, demonstration of IgM antibodies or by a 4-fold increase in IgG antibodies, between 1 January 2000 and 31 December 2014, reported to the Peace Corps’ Epidemiologic Surveillance System were analyzed. RESULTS Overall there were 1448 cases of dengue reported among Volunteers, with an incidence rate of 1.12 cases per 1000 Volunteer-months (95% CI 1.06-1.17). The highest rate of dengue among Volunteers was reported in the Caribbean region, with a rate of 5.51 cases per 1000 Volunteer-months (95% CI 4.97-6.10), followed by the East Asia/South Asia region (3.34, 95% CI 2.96-3.75) and Central America (2.55, 95% CI 2.32-2.79). The rate of dengue peaked in 2007, 2010 and 2013. Each peak year was followed by a trough year. CONCLUSIONS Globally, there appears to be a 3-year cyclical pattern of dengue incidence among Volunteers, with differences by region. Dengue continues to be a priority health issue for travellers to endemic areas, and enhanced surveillance of dengue among international travellers may result in improved patient education and prevention efforts.