Public Health Commons^™

Aids And A-Bomb Disease: Facing A Special Death, Chris Glaser

New England Journal of Public Policy

In 1979 it was called "gay cancer," and it took the life of an acquaintance. Then "gay-related immune deficiency," or GRID, claimed neighbors, friends of friends, fellow activists. I began grief and death counseling with a segment of the population ordinarily concerned with life's ambitions and enjoyments: men in their twenties and thirties. Hospital visits and memorial services became more frequent.

By 1983, when it had come to be called AIDS, my own friends began to be affected. One was a man I dated in seminary, and I was devastated to learn of his illness only upon receiving a notice …

Human Immunodeficiency Virus In Intravenous Drug Users: Epidemiology, Issues, And Controversies, Donald E. Craven

New England Journal of Public Policy

Intravenous drug users are the second most common risk group for acquired immunodeficiency syndrome (AIDS) in the United States, and they account for approximately 25 percent of the cases. Drug users may spread human immunodeficiency virus (HIV) by sharing contaminated drug injection paraphernalia and through sexual contact; women who use drugs can transmit the virus to their children. The rapid spread of HIV in this risk group and the fact that intravenous drug users are a source for heterosexual and perinatal transmission underscore the need for immediate intervention. In addition, many drug addicts are poor, have limited career possibilities, and …

New Hampshire: The Premarital Testing Debacle, Susan D. Epstein

New England Journal of Public Policy

In 1987, the New Hampshire Division of Public Health Services had a bill introduced in the legislature to improve contact tracing and establish statewide public education on HIV infection, transmission, and disease control. This article traces the bill, and issues surrounding the bill, through the legislative process and focuses on an unexpected intervention by the governor through a proposed amendment to add mandatory premarital testing. Its conclusions offer advice to other states on how best to avoid political exploitation of AIDS/HIV issues.

By the summer of 1987, the AIDS issue in New Hampshire had become devoted to everything but AIDS. …

Politics And Aids: Conversations And Comments, Steven Stark

New England Journal of Public Policy

As AIDS has emerged as a medical and social concern, it has become a political issue as well. In a series of interviews, we asked some leading authorities for their opinions on how AIDS is emerging as a political issue, particularly during the campaign of 1988. In all cases, the comments that follow represent an edited version of their remarks. Those participating were Ronald Bayer, director of the Project on AIDS and the Ethics of Public Health at the Hastings Center; William Schneider, resident fellow at the American Enterprise Institute; Jonathan Handel, a gay activist and a member of the …

The Clinical Spectrum Of Hiv Infections: Implications For Public Policy, Kenneth H. Mayer

New England Journal of Public Policy

The term acquired immunodeficiency syndrome (AIDS) is a definition developed by the Centers for Disease Control to explain the epidemic of immunosuppression first seen in the United States among gay and bisexual men and intravenous drug users in the early 1980s. It is now known that the human immunodeficiency virus (HIV) is the necessary agent for the compromise of the immune system which results in AIDS; however, there is a wide range of manifestations associated with HIV infection. Individuals with AIDS tend to have severe opportunistic infections or malignancies, and the vast majority ofindividuals die within two years after the …

Aids: An Overview, Loretta Mclaughlin

New England Journal of Public Policy

"We stand nakedly in front of a very serious pandemic, as mortal as any pandemic there ever has been," said Halfdan Mahler, director-general of the World Health Organization (WHO). "I don't know of any greater killer than AIDS, not to speak of its psychological, social and economic maiming. Everything is getting worse and worse with AIDS and all of us have been underestimating it, and I in particular. We're running scared. I cannot imagine a worse health problem in this century." When asked to compare AIDS to other epidemics, such as smallpox, that have infected and killed over the course …

Aids: Prophecy And Present Reality, Victor De Gruttola, William Ira Bennett

New England Journal of Public Policy

Mathematical modeling of the AIDS epidemic can be useful for policymakers even though precise projections are not possible at this time. Models are useful in establishing ranges for current and future prevalence of HIV infection and incidence of AIDS, as well as in predicting the effect of a given intervention strategy. Most decision makers are using models implicitly when they use epidemiological information as a basis for policy; formulating a model explicitly permits examination of the underlying assumptions. By creating and testing a variety of models, an investigator can determine whether the models reflect more the underlying assumptions or the …

The Quest For An Aids Vaccine, Robert T. Schooley

New England Journal of Public Policy

More than fifty thousand cases of AIDS have been reported in the United States since the disease wasfirst described in 1981. Many times this number of people are infected with human immunodeficiency virus (HIV), which has been identified as the agent responsible for the illness. The seriousness of the disease, coupled with the relatively rapid spread of HIV, has fueled the effort for development of an effective vaccine.

Much is now known about the life cycle of the virus, and about its structural components. This information, and information about methods of transmission of the virus, form the basis for a …

Medical Care Of Aids In New England: Costs And Implications, Stewart J. Landers, George R. Seage Iii

New England Journal of Public Policy

This article presents an overview of cost issues related to AIDS. Data from the Massachusetts Cost of AIDS Study are combined with epidemiological projections to estimate the cost of treating people diagnosed with AIDS in New England. Aggregate inpatient, ambulatory, and home care costs are estimated to be $96.9 million and $524.8 million through 1987 and 1991, respectively. These estimates represent a relatively small percentage of total health care costs for all illnesses over the same time period.

The authors find that the cost of treating AIDS does not affect all health care providers uniformly and therefore argue that appropriate …

Introducing Aids Education In Connecticut Schools, William Sabella

New England Journal of Public Policy

Most of the nation 's schoolchildren are not infected with the AIDS virus (HIV). Since AIDS is a preventable disease, no one need become infected. In order to protect themselves, everyone, including children, must understand exactly how HIV is and is not contracted. The message of prevention, however, is controversial, since it must include advice on safer sex and drug use.

In 1984, Connecticut was forced to face the issue of a child with HIV infection entering school. The state responded by creating guidelines for prevention of disease transmission in schools and by subsequently developing an AIDS curriculum. Obstacles to …

Hiv Antibody Screening: An Ethical Framework For Evaluating Proposed Programs, Ronald Bayer, Carol Levine, Susan M. Wolf

New England Journal of Public Policy

The acquired immunodeficiency syndrome (AIDS) poses a compelling ethical challenge to medicine, science, public health, the legal system, and our political democracy. This report focuses on one aspect of that challenge: the use of blood tests to identify individuals who have been infected with the retrovirus human immunodeficiency virus (HIV). In this article, we follow the terminology recently proposed by the International Committee on the Taxonomy of Viruses; that is, we use the term human immunodeficiency virus. This replaces the more cumbersome dual terminology of human T-cell lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV).

The issue is urgent: the tests are …

Behavioral Change In Homosexual Men At Risk Of Aids: Intervention And Policy Implications, Suzanne B. Montgomery, Jill G. Joseph

New England Journal of Public Policy

With more than fifty thousand cases of acquired immunodeficiency syndrome (AIDS) diagnosed since its initial recognition in 1981 and no cure or vaccine in sight, experts agree that prevention is of the utmost importance. Yet very little research has investigated how existing social-psychological and health behavioral knowledge can be applied to the special circumstances of programmatic responses to AIDS. One of the central aims of our own research group has been to describe the psychosocial determinants of successful behavioral risk reduction among homosexual men, the largest affected group. This work is reviewed and its implications for the development of intervention …

Aids Initiatives In Massachusetts: Building A Continuum Of Care, Nancy Weiland Carpenter

New England Journal of Public Policy

The Health Resource Office was officially established within the Massachusetts Department of Public Health in August 1985 to coordinate policy, education, research, and service response to the AIDS epidemic, and to focus attention on the social and economic impact of the disease. The actual work of the office was begun earlier, in October 1983. This article reviews the activities of the Health Resource Office from October 1983 through June 1987 in allocating resources for AIDS and ARC programs and services. It then describes the conceptual model that evolved during this period for the continuum of services needed to reduce HIV …

The Role Of Education In Aids Prevention, George A. Lamb, Linette G. Liebling

New England Journal of Public Policy

The severity of the current AIDS epidemic, combined with the lack of successful biological interventions, necessitates an active educational program as the primary intervention strategy. Health education theories abound, but relatively little definitive application of these theories has been made to the issues involved with HIV transmission: sexual behavior and the sharing of intravenous drug apparatus. Significant behavior changes have occurred in some people, but the consistency of the behavior change may be difficult to sustain. Thus, the authors suggest that health education should be delivered repeatedly in culturally acceptable language and format, by community leaders, and through many different …

U.S. Women And Hiv Infection, P. Clay Stephens

New England Journal of Public Policy

Women are inadequately provided with HIV services and education and are differentially denied access to these. Divisions of race, ethnicity, economic class, and religion, among others, are compounded by sexual discrimination within each of these categories.

Review of current data on women with AIDS reveals that the reporting methods used convey a false impression that women are not at significant risk. Moreover, the persons indirectly affected by AIDS are predominantly women — mothers, sisters, partners, family members, teachers, and human service workers. Thus, AIDS is more of a women's issue than the statistics imply.

Women, as a gender-defined class, face …

Aspects Of Endocrinology, Michael Kleerekoper, Raymond C. Mellinger

Henry Ford Hospital Medical Journal

No abstract provided.

An Overview Of Magnetic Resonance Imaging Of The Appendicular Musculoskeletal System, Sharon C. Siegel, Allan M. Haggar, Jerry W. Froelich, Burton I. Ellis

Henry Ford Hospital Medical Journal

No abstract provided.

Pituitary Metastasis: Lung Cancer Presenting As Bitemporal Hemianopsia With Diabetes Insipidus And Anterior Pituitary Deficiency, A. Keith Cryar, Jay Morgan, Jack P. Rock, Max Wisgerhof

Henry Ford Hospital Medical Journal

Symptoms and signs of pituitary disease are rarely the first manifestations of malignancy originating in another organ. We present a case which exemplifies the key points that suggest a diagnosis of metastatic pituitary disease. Our patient's diagnosis was adenocarcinoma of the lung with a metastasis to the intrasellar and suprasellar regions, which caused diabetes insipidus, anterior pituitary deficiency, and visual field defects. The metastasis had a dumbbell appearance and extended from the sella turcica into the suprasellar region. Diabetes insipidus was the initial clinical manifestation of lung cancer in this patient. A metastasis to the pituitary should be suspected if …

Pregnancy Following Sequential Bromocriptine Therapy In A Hyperprolactinemic Subject, Malachi J. Mckenna, M. Saeed-Uz-Zafar, Raymond C. Mellinger

Henry Ford Hospital Medical Journal

Regular menses were maintained in a 26-year-old woman with a prolactinoma by sequential bromocriptine therapy given for either five or 14 days of the menstrual cycle. She conceived promptly when desired.

Comparison Of Four High-Sensitivity Immunoradiometric Assays For Thyrotropin And Results Of Preliminary Clinical Studies, Malachi J. Mckenna, Earl Goad, Mohini Pimputkar, Carolyn S. Feldkamp

Henry Ford Hospital Medical Journal

New immunoradiometric assays (IRMAs) that detect low concentrations of thyroid-stimulating hormone (TSH) have recently become available for routine diagnostic use. These new assays have the putative advantage over conventional radioimmunoassay in that they can distinguish hyperthyroidism from euthyroidism by the finding of a serum TSH below the normal limit. In the present study we sought to evaluate four of these kits according to analytical performance characteristics and clinical utility. All IRM As could detect TSH at a concentration substantially below the lower limit of normal and thus effectively identify hyperthyroid samples. Although differences in the performance characteristics were found, all …

Neurobehavioral Symptoms In Mild Primary Hyperparathyroidism: Related To Hypercalcemia But Not Improved By Parathyroidectomy, Gregory G. Brown, Richard C. Preisman, Michael Kleerekoper

Henry Ford Hospital Medical Journal

The neurobehavioral symptomatology of severe primary hyperparathyroidism (PHPT) has been thoroughly described. Less is known about more mild cases. We evaluated 34 patients with mild PHPT and followed 19 for an average of six months. Of those cases followed, ten had parathyroidectomy (PTX). Patients with no neurobehavioral abnormalities had the lowest serum calcium levels (10.9 ± 0.88 mg/dL), patients with signs of affective disorder had intermediate levels (11.25 ± 0.66 mg/dL), and patients with signs of cerebral dysfunction had the highest levels (12.17 ± 1.17 mg/dL). Serum calcium significantly correlated with motor speed, psychomotor speed, fluid intelligence, and short term …

Back Matter

Henry Ford Hospital Medical Journal

No abstract provided.

Prolonged Remission Of Cushing's Disease Following Bromocriptine Therapy, Malachi J. Mckenna, Marc Linares, Raymond C. Mellinger

Henry Ford Hospital Medical Journal

A 33-year-old woman developed hypercorticism of fulminant onset following delivery of a full-term, normal child. An ectopic hormone-producing neoplasm was excluded by extensive studies. Pituitary dependent hypercorticism of intermediate lobe origin was suggested on the basis of onset following pregnancy, failure of Cortisol suppression by high-dose dexamethasone, hyperresponsiveness of prolactin to thyrotropin-releasing hormone stimulation, and reduction in adrenocorticotropin titers following oral administration of bromocriptine. Initial remission of disease achieved with bromocriptine was followed by recurrence on discontinuation of the agent. However, complete remission which occurred following a prolonged course of bromocriptine has persisted for a total of 22 months.

Front Matter

Henry Ford Hospital Medical Journal

No abstract provided.

Hypothalamic Hypogonadotropic Hypogonadism In An Adolescent Male: A Rare Manifestation Of Aqueductal Stenosis, Robert J. Wilson, Max Wisgerhof

Henry Ford Hospital Medical Journal

No abstract provided.

Naltrexone Does Not Affect Adrenal Steroidogenesis In Women With Hirsutism/Oligomenorrhea, Jeffrey A. Jackson, Thomas J. Wincek, Jose F. Pliego

Henry Ford Hospital Medical Journal

We studied the effects of the oral opiate receptor antagonist naltrexone on basal and ACTH-stimulated adrenal steroid levels in six women with hirsutism/oligomenorrhea and preexisting elevation of serum dehydroepiandrosterone sulfate. One of the six patients met the criteria for partial 3-β-hydroxysteroid dehydrogenase deficiency. No statistical differences were detected in steroid levels or ratios before and after 14 days of 50 mg/day of naltrexone. Thus, we find no support for the hypothesis that opioid peptides acting through opiate receptors (predominantly μ subtype) modulate the abnormal adrenal androgen secretion seen in these women with hirsutism/oligomenorrhea.

Hyperthyroidism Due To A Thyrotropin-Secreting Pituitary Microadenoma, Jeffrey A. Jackson, Mitchell Smigiel, John F. Green Jr.

Henry Ford Hospital Medical Journal

A 52-year-old man presented with elevated thyroid hormone levels and an inappropriately normal serum thyrotropin (TSH) (4.0 μU/mL: normal 0.5 to 6.0 μU/mL). Computed tomography suggested an intrasellar mass without radiographic sellar enlargement. Serum alpha-subunit was elevated with flat responses of both alpha-subunit and TSH to thyrotropin-releasing hormone. Transsphenoidal adenomectomy resulted in clinical and biochemical cure with subsequent development of hypothyroidism with otherwise preserved anterior pituitary function. Pathologic studies demonstrated an 8 mm typical thyrotroph cell adenoma. Early diagnosis of such tumors requires a high index of clinical suspicion and may be facilitated in the future by utilization of highly …

Primary Hyperparathyroidism And Associated Neoplasms, Angelos A. Kambouris, Mohammed R. Ansari, Gary B. Talpos

Henry Ford Hospital Medical Journal

No abstract provided.

Effects Of Weight Reduction, Exercise, And Diet Modification On Lipids And Apolipoproteins A-L And B In Severely Obese Persons, J. David Fachnie, Craig C. Foreback

Henry Ford Hospital Medical Journal

We assessed the lipid and apolipoprotein effects of hypocaloric dieting, increased physical activity, and dietary modification in severely overweight adults (body mass index [BMI] 43.05 kg/m-). The 34 women and four men enrolled in the ambulatory weight control program donated blood before, during, and after hypocaloric dieting (420 kcal/day). Mean values before dieting included cholesterol of 223 mg/dL, high-density lipoprotein (HDL) cholesterol of 43 mg/dL, and cholesterol/HDL cholesterol of 5.90. This placed our subjects at high risk for coronary artery disease. Other values included triglycerides of 138 mg/dL, apolipoprotein A-l of 152 mg/dL. and apolipoprotein B/apolipoprotein A-l of 0.64. Significant …

Renal Involvement In Type 2 Diabetes Mellitus: A Clinicopathologic Study Of The Henry Ford Hospital Experience, Francis Dumler, Vijay Kumar, Raymond N. Romanski, Pedro Cortes, Nathan W. Levin

Henry Ford Hospital Medical Journal

To better understand renal dysfunction in type 2 diabetes mellitus, we studied the clinical and autopsy findings in comparable cohorts of 108 diabetic and 77 nondiabetic patients. In the diabetic group, no differences were noted between black and white patients in blood glucose concentrations, mean blood pressure, or the prevalence of diabetic glomerulosclerosis. However, the prevalence of renal insufficiency was significantly greater (P = 0.002) in black diabetics (58%) than in white diabetics (35%). black controls (28%), and white controls (20%). Logistic regression analysis demonstrated a significant association of renal insufficiency with diabetes (P = 0.006) and race (P = …