Biomedical subjects
Publications and source records attributed to B Berlin.
Concerns about bioterrorism have grown in recent years. The fear of bioterrorism is as potent as the genuine risk. In this new age of potential biological warfare, emergency medical preparedness must be on target. Physicians must be ready to alert public health authorities.
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At first glance, there would seem to be little controversy over cardiac catheterization, a diagnostic procedure used to evaluate problems with heart function and blood supply. In a typical cardiac catheterization, a long thin tube is inserted through blood vessels into the heart to evaluate blood pressure, inject dye, and take x-rays.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
During the 1989 gubernatorial race, Jim Florio liked to say that a political campaign is a conversation--a time for candidates and voters to communicate aspirations and concerns, an opportunity for political engagement and dialogue. An election campaign is a time when citizens pay more attention to politics, and candidates have more personal contact with voters. For both citizens and candidates, a campaign at its best is a time for education.
A 57-year-old corporate executive, married with three grown children, began suffering from severe flu-like symptoms and weight loss. Hospitalized for a week, he was tested for chronic fatigue syndrome and mononucleosis. Finally, with no change in his symptoms, his physician recommended an HIV test. The results were positive.
John Adessa is unhappy with the direction managed care has taken in this country, and he is doing something about it. Adessa, the chief executive officer of First Option Health Plan, dislikes the burden of risk that falls on physicians through capitation arrangements, and he does not believe that patients should be severely restricted in their access to physicians.
Richie T. is a teenager from an affluent family in Westfield, where he attends the local high school. His grades are good and he expects to go to a major out-of-state university next year. Richie hangs out with different cliques, drinks occasionally at weekend parties, and likes a girl who does not seem to notice him. Richie started smoking Marlboros last year. He likes the taste of tobacco and says that his friends who smoke are "cool" and "interesting." He sees a lot of adults who smoke, and he is certain he could quit whenever he feels like it. Richie does not think about the health effects of smoking, and apparently he is not alone.
The tremors that are shaking the world of medicine are reshaping the landscape of graduate medical education (GME), and along with it, the future of the medical profession in the United States. GME--essentially medical residencies and, to a lesser extent, research fellowships--is the crossroads where career aspirations become professional choices, and where decisions are made, both on a macro and micro level, that will shape medicine for years to come.
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While ethnobotany has emerged as an important discipline in the search for new drugs, this economic impetus should in no way distract from a more ethnobiological and equally critical goal--the codification and promotion of indigenous medical systems as a major factor in the conservation of biocultural diversity. Codification of indigenous medical systems requires a holistic view which entails (1) in-depth understanding of the recognized health conditions in the native system and how they might be described in terms of Western biomedicine; (2) comprehensive inventories of medicinal species employed in the native system, descriptions of their modes of preparation and administration and giving priority to those species most likely to merit pharmacological testing; and (3) identification of the pharmacological properties of these species with the goal of discovering how they might be effective in the treatment of the health conditions for which they are employed. Promotion of indigenous medical systems requires the development of local training programmes aimed at the active conservation and enhancement of traditional herbal medicinal therapies that have been shown to be pharmacologically effective in the treatment of symptoms of recognized health conditions. The establishment of such programmes is critical at a time when traditional medical systems are often disparaged as worthless by the national societies in which indigenous peoples live, as well as by younger members of the native populations themselves.
In 1990, 3049 Boston public middle and high school students were surveyed anonymously in English, Spanish, Vietnamese, Chinese, French, or Haitian Creole. Significantly fewer immigrant students, 35% of those surveyed, knew the principal modes of human immunodeficiency virus transmission. Fewer immigrants reported having sexual intercourse (31% vs 53% of nonimmigrants), but among the sexually active only 38% always used condoms, and more immigrants reported intercourse with intravenous drug users (4% vs 1% of non-immigrants). AIDS education should be taught to immigrant students in their native languages.
Despite substantial progress, adolescents remain at high risk for human immunodeficiency virus (HIV) infection. Two independent random digit dial statewide Massachusetts surveys of 16- to 19-year-old persons conducted August through September 1986 and 1988 revealed that the proportion of teenagers who had discussed acquired immunodeficiency syndrome (AIDS) in schools increased from 52% to 82%. Knowledge about how AIDS is transmitted was also significantly higher in 1988. The proportion of teenagers using drugs other than alcohol and marijuana declined from 13% to 9%, and intravenous drug use declined from 1% to 0.1%. At the same time, among sexually active teenagers, the proportion who reported changes in sexual behavior to avoid AIDS increased from 16% to 34%. The proportion who adopted condom use to avoid AIDS increased from 2% to 19%. However, the overall proportion of teenagers who reported sexual intercourse in the past year increased significantly from 55% to 61%. In 1988, among sexually active teenagers, 37% never used condoms and 33% used them only some of the time. Of all respondents, 18% reported unprotected sex with more than one partner in the previous year, and 3% reported unprotected sex with intravenous drug users. Although mass media and school education may increase knowledge and stimulate some teenagers to change behavior, for others more personal forms of counseling may be needed. The effects of increasing physician counseling warrant special study. Teenagers who had spoken to physicians about AIDS were much more likely to have adopted condom use to avoid HIV exposure. However, although 80% of adolescents saw a physician in the past year, only 13% were counseled about AIDS.
In October 1987, 1,323 Massachusetts residents were randomly interviewed by telephone to explore their exposure to AIDS educational efforts, levels of knowledge about AIDS, and whether that knowledge modified their behavior. Gay/bisexual males, iv drug users and heterosexual respondents were compared as were blacks, Hispanics, and whites. While 81% of respondents had read or heard mass media stories about AIDS, in the previous week, only 5% had ever been counseled about AIDS by a physician. Over 97% of black (N = 152) and white respondents (N = 1,057), as well as gay/bisexual males (N = 21) and iv drug users (N = 33) were aware that HIV can be transmitted by homosexual or heterosexual intercourse and by sharing needles when injecting drugs. However, 9% of the 55 Hispanics interviewed were unaware of male homosexual transmission, and 7% did not know about heterosexual transmission or the risks of needle sharing. Twenty percent of Hispanics, compared with 9% of other respondents, did not know HIV can be transmitted sexually by someone who appears healthy. Fifty-two percent of gay/bisexual males, 27% of iv drug users, and 21% of those who had multiple heterosexual partners in recent years reported adopting abstinence, monogamous relations, or condom use to avoid HIV exposure. Those who continued risky behavior were just as knowledgeable about HIV transmission, but they were less likely to report that they worry a great deal about getting AIDS, 14% vs 32%. The results indicate that new strategies and resources are needed to educate Hispanics. Physicians need to counsel more persons about HIV transmission and further efforts are needed to translate knowledge about HIV transmission into behavior change to avoid the virus.