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Biomedical subjects

B Stimmel

Publications and source records attributed to B Stimmel.

At least 55 records · Page 3Linked to original sources
PubMed1986

Cocaine use in persons on methadone maintenance.

Although cocaine use had increased dramatically among all levels of society over the past several years, its use by heroin addicts has existed for decades. To determine whether the prevalence or the pattern of cocaine use changes once an addict enrolls in methadone maintenance, a survey of cocaine use among persons in methadone maintenance therapy was conducted. Of the 613 persons surveyed, 229 (37%) chose to participate, with 33 (14%) considered invalid because of incomplete responses. Of the remaining 196 (86% of the participants), 64 (33%) indicated no cocaine use prior to methadone maintenance, and 132 (67%) reported some prior use. Once treatment had begun, 9 (14%) with no history of prior use admitted to at least one event within the last 6 months, and 55 (86%) reported no use. Of those reporting use prior to methadone maintenance, 41 (31%) stopped usage and 91 (69%) continued. Of the total participants, approximately half used cocaine at least once during methadone maintenance. Among those who used cocaine before and during methadone maintenance, the predominant route of administration was parenteral, 72 (54%) and 46 (51%) participants, respectively. It should be noted that there was a net gain of 17% of patients who stopped using cocaine as a result of entering methadone maintenance. Indices of cocaine use by random urinalysis over the preceding 6 months, for the entire clinic population, revealed only 86 (14%) to 110 (18%) patients to have urine samples positive for cocaine. Although cocaine use decreased on methadone maintenance, its use is still considerable, with the pattern of use differing from the recreational cocaine use in a non-narcotic-dependent population. Random urinalysis for cocaine appears to be an insensitive indication of prevalence of use.

Cocaine↗
PubMed1985

Career choice of 'fifth pathway' graduates from New York state medical schools.

Graduates of "fifth pathway" programs at medical schools in New York state between 1976 and 1978 were studied to determine their professional careers and choice of medical specialties. Of the 545 physicians participating in the program, 510 were able to be located. Of this latter cohort, 177 (34.7 percent) had entered primary care fields as of 1981. Of the physicians no longer in residency training, 19.1 percent had full-time salaried positions in academic institutions, and the remaining physicians were engaged in various clinical medical activities. Of the 545 fifth pathway graduates, 74 (13.6 percent) had not been able to pass the licensing examinations as of 1981, and an additional 54 (9.9 percent) had not taken those examinations. Comparisons with regular students graduating from a medical school in New York state showed that fifth pathway graduates were more likely to select nonprimary care specialties than primary care specialties (p less than 0.001). These data suggest that although a majority of graduates of fifth pathway programs in New York state are involved in the provision of health care, a small number are still unable to engage in the practice of medicine.

Career Choice↗
PubMed1984

Medical students trained abroad and medical manpower. Recent trends and predictions.

Physicians trained in foreign medical schools, including U.S. citizens, are once again playing a larger part in the provision of medical are in this country. After a decrease in the numbers of such physicians from 1977 through 1980, the number of foreign nationals entering the National Resident Matching Program increased by 312 per cent, and the number of U.S. citizens from foreign schools increased by 273 per cent. U.S. graduates of foreign medical schools participating in Fifth Pathway programs appear to benefit from their extra year of clinical training by being more successful in the National Resident Matching Program and having a higher pass rate on state licensing examinations. These increases in physicians trained in foreign medical schools, together with an increasing number of students graduating from U.S. medical schools, have resulted in an insufficient total number of first-year postgraduate positions, regardless of the specialty, to accommodate all physicians seeking a first-year residency. Since the number of residency positions will probably not expand to meet applicant demand, an increase in the pool of physicians with neither residency training nor licenses to practice medicine is likely. Alien foreign medical-school graduates and U.S. students who go abroad to study medicine can no longer take for granted residency training and practice in the United Stages.

Educational Measurement↗
PubMed1983

Failure of mean red cell volume to serve as a biologic marker for alcoholism in narcotic dependence. A randomized control trial.

Mean red cell volume, mean red cell hemoglobin, and mean red cell hemoglobin concentration were measured in a prospective, longitudinal, single-bind study of alcoholism and its treatment in 625 patients receiving methadone. Mean red cell volume and mean red cell hemoglobin were significantly elevated in alcoholic as compared with nonalcoholic patients (p less than 0.001), with a sensitivity of 40 and 51 percent, respectively. The ability of an elevated mean red cell volume and mean red cell hemoglobin to exclude active alcoholism (specificity) was 86 and 76 percent, respectively. Development of excessive consumption of alcohol during the course of the study was not associated with significant elevations over baseline values of either mean red cell volume or mean red cell hemoglobin. Similarly, the mean red cell volume and mean red cell hemoglobin in the small number of patients whose consumption of alcohol markedly decreased did not significantly change from baseline values. These findings suggest that although the specificity of mean red cell volume may be helpful in eliminating those persons who are not actively alcoholic, its sensitivity does not permit its use as a biologic marker for alcoholism. The inclusion of an elevated mean red cell volume as a major criterion for the diagnosis of alcoholism should be reconsidered.

Alcohol Drinking↗
PubMed1983

Loitering by patients on methadone maintenance: a perception or a problem.

Loitering has become an increasing matter of concern to both communities and staff involved in drug treatment programs. In order to determine the prevalence of this problem a retrospective two-year study was performed among clients enrolled in a community methadone maintenance treatment program (MM). Of 1064 persons enrolled in MM during this time, 190 (17.8%) were identified as loiterers with 121 (63.7%) loiterers actively enrolled in MM. No significant differences between loiterers and a matched group of MM clients were seen with respect to time in treatment, presence of drug abuse or excessive alcohol intake. Differences between loiterers and non-loiterers were observed with respect to criminal activity (29% vs. 11%, respectively, P less than 0.001), non-opioid drug abuse (78% vs. 67%, respectively, P less than 0.01) and productive activity (44% vs. 61%, respectively, P less than 0.01). Excessive alcohol intake was seen in 15.4% of the study group. No relationship existed between excessive consumption of alcohol and loitering, arrests, and use of mood altering drugs as determined by urinalysis. No relationship could be demonstrated between loitering and residence in the community surrounding the program. Only 11 (6%) of all loiterers lived within two blocks of the program boundaries, and only 59 (31%) resided within East Harlem. These findings suggest that loitering is a real cause for concern being engaged in mainly by individuals who are neither socially productive nor residents of the immediate community surrounding the program. It is therefore important to develop strategies for dealing with this problem not only to reassure the community but to facilitate rehabilitation.

Adult↗