Public Health Commons^™

Sleep Disorders Medicine, Thomas Roth

Henry Ford Hospital Medical Journal

No abstract provided.

Familial Childhood Sleep Apnea, Robert M. Wittig, Frank J. Zorick, Timothy A. Roehrs, Jeanne M. Sicklesteel, Thomas Roth

Henry Ford Hospital Medical Journal

We report four siblings who had polysomnographically documented sleep apnea. Two presented with the typical clinical picture of sleep apnea syndrome including daytime somnolence and snoring, had repetitive obstructive apneic episodes during sleep, and were effectively treated with upper airway surgery. The other two were asymptomatic and showed infrequent apneic episodes during sleep. This family illustrates the distinction between the sleep apnea syndrome and infrequent apneic episodes during sleep. The sleep apnea syndrome is associated with daytime symptomatology and requires treatment. The presence of apneic episodes during sleep in all four siblings has implications regarding the predisposing factors (eg, upper …

Anticoagulant Therapy, Antithrombotic Therapy, Pulmonary Embolism, And The Henry Ford Hospital Perspective, Paul D. Stein

Henry Ford Hospital Medical Journal

No abstract provided.

Clinical Manifestations Of Acute Pulmonary Embolism: Henry Ford Hospital Experience, A Five-Year Review, Kenneth V. Leeper Jr., John Popovich Jr., Deborah Adams, Paul D. Stein

Henry Ford Hospital Medical Journal

Clinical findings of 112 patients with angiographically proven pulmonary embolism over a five-year period were analyzed. Recent immobilization, chronic heart disease, deep venous thrombosis, malignancy, and recent surgery were the most frequent predisposing factors. Only 5% had no identifiable risk factors. Presenting syndromes were circulatory collapse (25%), pulmonary infarction (59%), and uncomplicated pulmonary embolism (18%). Dyspnea and pleuritic chest pain were the predominant symptoms. The combination of dyspnea, pleuritic chest pain, and hemoptysis occurred in 23% of the patients. The most frequent signs were tachypnea, tachycardia, and rales. Most of the patients demonstrated arterial oxygen tension (PaO2) between 50 and …

Disseminated Strongyloides Stercoralis And Aspergillus Fumigatus Presenting As Diffuse Interstitial Pneumonitis In A Steroid-Dependent Chronic Obstructive Pulmonary Disease Patient, Larry Tankanow, Michael S. Eichenhorn

Henry Ford Hospital Medical Journal

We describe a patient with long-standing steroid-dependent chronic obstructive pulmonary disease who was admitted with new diffuse interstitial pulmonary infiltrates. Strongyloides stercoralis was present in the sputum and stool and responded to treatment. However, complicating disseminating Aspergillus fumigatus infection eventuated in the patient's death. Strongyloides stercoralis infection should be considered in patients with relevant exposure history, and complicating fungal and gram-negative bacterial infections which such patients may develop should be suspected.

Cancer Mortality Among Residents Of Huron, Sanilac, And Tbscola Counties As Compared To Other Michigan Residents, 1971-1985, Jennifer A. Booms, William Benish

Henry Ford Hospital Medical Journal

Age-adjusted cancer mortality rates in the "Thumb" area of Michigan (Huron, Sanilac, and Tuscola counties) were compared with those for the rest of the state from 1971 to 1985. Comparisons were made after partitioning the mortality data on the basis of the patient's sex, year of death (1971 to 1975, 1976 to 1980, or 1981 to 1985), and site of primary tumor. International Classification of Diseases categories were combined to define 29 cancer site groups. The analysis was limited to the white population. The major observation was a consistently lower mortality rate of lung cancer in the Thumb area than …

Enteric-Coated Fenoprofen In Large-Joint Osteoarthritis, Gilbert B. Bluhm, Harris H. Macilwain, Walter W. Offen

Henry Ford Hospital Medical Journal

Enteric-coated fenoprofen was compared with standard fenoprofen (Nalfon, Dista, Indianapolis, IN) in a randomized, double-blind, parallel, three-month trial of 113 outpatients (mean age, 64 years) with large-joint osteoarthritis. A previous study showed that enteric coating of fenoprofen reduces gastrointestinal microbleeding and may offer a safety advantage. Both treatments provided statistically significant improvement in pain measures (tenderness on pressure, pain at rest, pain with weight-bearing activity, and pain on passive motion). Adverse experiences were similar with both treatments and of an expected type, severity, and incidence for nonsteroidal anti-inflammatory drugs. Enteric-coated fenoprofen was found to be as effective and safe as …

Malignant Lymphoma Presenting In Gluteal Muscles: Case Report And Brief Review Of The Literature, Roberta Sonnino, Angelos A. Kambouris

Henry Ford Hospital Medical Journal

No abstract provided.

Potency Of Current Levothyroxine Preparations Evaluated By High-Performance Liquid Chromatography, Sheldon S. Stoffer, Walter E. Szpunar

Henry Ford Hospital Medical Journal

Ten different levothyroxine products manufactured by six companies were analyzed by high-performance liquid chromatography. Although nine products met the United States Pharmacopeia requirements, one product was found to have only 47% of expected potency. Until these products become more uniform, we would not recommend interchangeability of levothyroxine preparations.

Jack S. Guyton, Md, Cornelius E. Mccole

Henry Ford Hospital Medical Journal

No abstract provided.

Editorial: Responsibilities Of Authorship: Justification Of The Multiauthored Scientific Paper, Sarah Whitehouse, Raymond C. Mellinger

Henry Ford Hospital Medical Journal

No abstract provided.

Patricia K. Townsend's Review Of Leslie B. Marshall's Infant Care And Feeding In The South Pacific, Patricia K. Townsend

Pacific Studies

No abstract provided.

The Aids Epidemic: A Prism Distorting Social And Legal Principles, Alec Gray

New England Journal of Public Policy

The AIDS epidemic is affecting American society in far-reaching and unexpected ways. It touches our institutions, our value systems, and our private lives. Social issues seem to change and become distorted by the epidemic 's prismlike effect. This article examines some of the major public health issues raised by the epidemic, ranging from testing to contact tracing and quarantine. It argues that while the civil rights of individuals may have to be sacrificed to stem the spread of the disease, those rights should not be abandoned unless a clear benefit to the public health would result.

Issues of discrimination in …

Aids And New England Hospitals, Jesse Green, Neil Wintfeld, Madeleine Singer, Kevin Schulman

New England Journal of Public Policy

The Centers for Disease Control projects that nine thousand persons with AIDS will be alive in New England in 1991, representing a sevenfold increase from 1986. Our analysis indicates that more than 2 percent of medical/surgical beds in New England will be used for AIDS care by 1991, representing 766 fully occupied hospital beds. The direct cost of providing hospital care to New England's AIDS patients is projected to be $195.2 million in 1991, reflecting 3 percent of all hospital inpatient costs in the region.

AIDS treatment is very unevenly distributed among hospitals in New England. Just twenty hospitals (8 …

Epidemiology And Health Policy Imperatives For Aids, Katherine Hill Chavigny, Sarah L. Turner, Anne K. Kibrick

New England Journal of Public Policy

The purpose of this article is to describe the statistics and epidemiological facts about the most virulent epidemic of our age, acquired immunodeficiency syndrome (AIDS). The discussion argues for broadened public policy to promote the surveillance of communities in order to enhance the effectiveness of data gathering for epidemiological reasoning, analysis, and control measures. To accomplish these goals, the essential characteristics of epidemiology are defined. The use of deductive and inductive reasoning is applied to describe and analyze known facts concerning the AIDS epidemic. Hypotheses are suggested from current amorphous and continually changing information to assist in further explanations of …

Neuropsychiatric Complications Of Hiv Infection: Public Policy Implications, Alexandra Beckett, Theo Manschreck

New England Journal of Public Policy

The human immunodeficiency virus (HIV) infects the central nervous system (CNS), causing symptoms in most persons with AIDS-related complex (ARC) and AIDS, and in a significant proportion of those classified as asymptomatic seropositive. The most common clinical syndrome secondary to CNS infection is known as HIV encephalopathy. When sufficiently disabling, HIV encephalopathy is known as AIDS dementia, and must be reported to the Centers for Disease Control as a case of AIDS.

AIDS dementia is a complex of cognitive, affective, behavioral, and motor symptoms which varies widely in its presentation. In some persons, cognitive impairment predominates, manifesting in a loss …

Understanding The Psychological Impact Of Aids: The Other Epidemic, Marshall Forstein

New England Journal of Public Policy

HIV has created two epidemics, one of disease, the other the consequence of the psychological response to that disease. Thus far, behavioral change is the only effective means of interrupting the transmission of HIV. The underlying psychological dimensions of the societal and individual responses to AIDS are discussed, with suggestions for how both rational thinking and irrational fears and anxiety contribute to the development of public policy. Examples are given of how short-term solutions to reduce anxiety may actually create long-term problems, potentially increasing the risk of transmission of HIV. Specific psychological mechanisms that contribute to the epidemic of fear …

Ethical Issues In Aids Research, Michael A. Grodin, Paula V. Kaminow, Raphael Sassower

New England Journal of Public Policy

There is a need for carefully controlled and scientifically rigorous research studies of the acquired immunodeficiency syndrome (AIDS). The morbidity and mortality associated with AIDS patients and the public health concerns for control of this epidemic have distorted the usual process of research. The Institutional Review Board at Boston City Hospital is suggested as an appropriate mechanism for clarifying the distinctions between research and innovative therapies and for assuring the protection of this vulnerable population of research subjects. This article addresses ethical concerns relating to the time frame of research, drug and antibody testing, vaccine trials, and questions of justice …

Minorities And Hiv Infection, Veneita Porter

New England Journal of Public Policy

This article discusses a preliminary comparison of responses to AIDS in ethnic communities and their basis in previously established support systems. The importance of public policy and its connection to racism and cultural insensitivities are discussed as they relate to communities of color at risk. Particular attention is paid to problems of communication and to the ethics involving confidentiality.

Call To Action: A Community Responds, Larry Kessler, Ann M. Silvia, David Aronstein, Cynthia Patton

New England Journal of Public Policy

This article will examine the early formation of the AIDS Action Committee of Massachusetts, and what it has become. It will examine particular philosophical and organizational conflicts, some unique to AIDS organizing, that have influenced the direction the group has taken. It will try to tease out some of the factors that have made the organization successful in delivering services, providing education, and affecting city and state policy. It will also examine some of the unresolved conflicts that threaten the organization.

Aids Public Policy: Implications For Families, Elaine A. Anderson

New England Journal of Public Policy

Much has been written about the AIDS crisis in the past few years. However, relatively little of this discussion has focused on AIDS as it may affect families. This report emerged from the 1987 Groves Conference on Marriage and the Family. It is a version of the chapter on public policy in AIDS and Families (ed. Eleanor Macklin, Hayworth Press, forthcoming, summer 1988), prepared by the conference's Task Force on AIDS and Families. The book details the probable impact of AIDS on individuals, families, and communities and delineates the implications for relevant professionals, organizations, and public policy. Those individuals who …

New England And National Resources: For People With Aids, Arc, Or Hiv Infection, Their Families, And Friends, Diane Fentress, Betsy Anne Youngholm

New England Journal of Public Policy

A listing of resources and services, compiled in 1988 for this issue, for people with AIDS, ARC, or HIV, as well as their families and friends.

List Of Terms

New England Journal of Public Policy

Lists and defines terms relevant to the study of HIV/AIDS that are used throughout this issue of the New England Journal of Public Policy.

The Acquired Immunodeficiency Syndrome In New England: An Epidemiological Review Of The First Six Years, Laureen M. Kunches, Jeanne M. Day

New England Journal of Public Policy

Between 1981 and 1987 — the six-year period following initial recognition of the acquired immunodeficiency syndrome (AIDS) — 1,475 cases were reported among residents of the six New England states. Of nearly 40,000 cases nationwide, 3.8 percent occurred among New England residents, though the region 's population represents 5.5 percent ofthe total United States population. The groups most affected include homosexual or bisexual men (65 percent) and intravenous drug users (20 percent). However, in the two southernmost states — Rhode Island and Connecticut — 32 to 40 percent of all cases have used intravenous drugs. In these states, the male:female …

The Hiv Seropositive State And Progression To Aids: An Overview Of Factors Promoting Progression, Paul H. Black, Elinor M. Levy

New England Journal of Public Policy

We have considered factors that predispose to infection by the human immunodeficiency virus as well as the clinical consequences of infection. We have also reviewed what is known about the virological status of the asymptomatic carrier, particularly the female, and the fact that pregnancy may be a cofactor for progression of HIV disease in seropositive women. Additionally, we have discussed several other cofactors that may promote the progression of HIV infection. These include intercurrent infection, excessive use of recreational drugs and alcohol, malnutrition, and stress. With respect to stress, we have reviewed evidence indicating that certain personality factors, by buffering …

A Crisis In Insurance, Benjamin Lipson

New England Journal of Public Policy

As the life and health insurance industry evaluates its long-term financial goals, the cloud of Black Monday — October 19, 1987, the day the stock market collapsed — blurs its cherished investment income projections. With investment portfolios under siege, mutual life insurance companies and stock companies alike are wary of making policy-pricing miscalculations that could prove to be disastrous. As if that weren't enough, one single disease — acquired immunodeficiency syndrome — looms as the most serious threat to life and health insurers for the remainder of this century. The spread of the new disease has caused insurers to adjust …

Editor's Note, Padraig O'Malley

New England Journal of Public Policy

On occasion, the New England Journal of Public Policy will devote an entire issue to consideration of a public policy matter of major importance. The AIDS epidemic is such a matter, with a likely impact of overwhelming consequence well into the twenty-first century. The epidemic raises fundamental questions regarding the nature of individual freedom, our responsibilities to others, the always delicate balance between private rights and the public interest, and society's obligation to its "out" groups — whose members it has stigmatized, discriminated against, ridiculed, and treated as less than full and equal citizens. Indeed, it requires us to ask …

Human Retroviruses: Illustration

New England Journal of Public Policy

An illustration of human retroviruses and the life cycle of retroviruses.

Aids In Children: An Overview Of The Medical, Epidemiological, And Public Health Problems, Ellen R. Cooper

New England Journal of Public Policy

Cases of AIDS in children under thirteen years of age have been described since 1982. Diagnosis is more difficult in children than in adults, owing to the more varied clinical presentation and the difficulty in interpretation of laboratory tests. Current diagnostic criteria of HIV infection are reviewed, as well as symptomatology, natural history, and controversies surrounding management and therapy. Without a full appreciation of the transmissibility of HIV, issues including school and day-care attendance and foster family placement remain emotionally charged. Conflicting public policies contribute to fears on the part of the general public. Because ofthe unique implications for the …

Hiv Antibody Testing: Performance And Counseling Issues, Michael Gross

New England Journal of Public Policy

This article assesses the performance of currently used tests for exposure to human immunodeficiency virus (HIV), the infectious agent associated with acquired immunodeficiency syndrome (AIDS); suggests, in view of that information, guidelines for counseling people seeking HIV antibody testing; and evaluates the claim that because antibody test results will effect behavior change in those who are infected, all members of high-risk groups should be tested.

HIV testing is likely to yield a high proportion of false-positive results in low-risk populations and infants born to infected mothers. A negative result may not establish freedom from infection in high-risk groups or the …