Faculty Bibliography

WHEN AIDS was first recognized in New York in 1981, it was not as a viral infection but as Kaposi's sarcoma, a rare type of cancer affecting the skin and internal organs. After realizing that AIDS was a new disease, doctors then noticed that two other unusual types of cancer -- non-Hodgkins lymphoma and primary lymphoma of the brain -- also occurred with unusual frequency among people with H.I.V., the AIDS virus. Because H.I.V. suppresses the immune system and most AIDS-related cancers are strongly associated with viruses, scientists saw in the tragedy of the AIDS epidemic an extraordinary opportunity to study the interplay of viruses, an impaired immune system and the development of cancer. In a way, AIDS research was an extension of the war on cancer that the Government declared in 1971. Researchers are broadening their understanding of the number and types of viruses that might play a role in cancer. Now, for example, there is increasing evidence of a link between Kaposi's sarcoma and a recently discovered herpes virus known as H.H.V.-8. Researchers also report an apparent decline in two types of AIDS-related cancers after the introduction of newer anti-H.I.V. combination drug therapy

For the first time, a drug has been shown to prevent breast cancer among women at high risk for the disease, a jubilant group of federal health officials said Monday. Women who took the drug, tamoxifen, had 45 percent fewer cases of breast cancer than a group of women who took a dummy pill or placebo. The drug helped all age groups in a large study, they said. The health officials said the study results are historic and may lead to development of drugs to prevent other cancers. But because tamoxifen also carries risks of life-threatening adverse effects, such as cancer of the uterus and blood clots that migrate to the lungs from veins in the legs, women were cautioned not to rush to demand the drug before statisticians and other experts do further analyses, so that doctors can interpret the findings for individual women

A group of women who took the drug, tamoxifen, in a large study had 45 percent fewer cases of breast cancer than a group of women who took a placebo, or dummy pill. Health officials said the drug helped women in all age groups and, calling the results historic, said they hoped the findings would lead to the development of drugs to prevent other cancers. But because tamoxifen also carries risks of life-threatening adverse effects, like cancer of the womb and blood clots that reach the lungs from veins in the legs, women were left with a complex decision about the best course to protect their health. Thus they were cautioned not to rush to demand the drug until statisticians and other experts have time to do the further analyses needed for doctors to tailor the findings to individual women. Such analyses should take about two months, Dr. Harold Varmus, the head of the National Institutes of Health, in Bethesda, Md., said in a brief interview. ''As with any medication, the decision to begin tamoxifen therapy is a very complex one,'' said Dr. Leslie Ford of the National Cancer Institute, also in Bethesda. Dr. Ford said that ''even if a woman is at increased risk of breast cancer, tamoxifen therapy may not be appropriate for her'' and ''there are no simple answers.''

For the first time, a drug has been shown to prevent breast cancer among women at high risk for the disease, a jubilant group of federal health officials said yesterday. Women who took the drug, tamoxifen, had 45 percent fewer cases of breast cancer than a group of women who took a dummy pill, or placebo. The drug helped all age groups in a large study, they said. The health officials called the study results historic and said they hoped they would lead to development of drugs to prevent other cancers. But because tamoxifen also carries risks of life-threatening adverse effects, such as cancer of the uterus, and blood clots that migrate to the lungs from veins in the legs, women were cautioned not to rush to demand the drug until statisticians and other experts do further analyses so that doctors can interpret the findings for individual women

OBJECTIVE: To assess the effect of a screen for problem drinking on medical residents and their patients. DESIGN: Descriptive cohort study. SETTING: Veterans Affairs Medical Clinic. PATIENTS: Patients were screened 2 weeks before a scheduled visit (n = 714). Physicians were informed if their patients scored positive. MEASUREMENTS AND MAIN RESULTS: Physician discussion of alcohol use was documented through patient interview and chart review. Self-reported alcohol consumption was recorded. Of 236 current drinkers, 28% were positive for problem drinking by the Alcohol Use Disorders Identification Test (AUDIT). Of 58 positive patients contacted at 1 month, 78% recalled a discussion about alcohol use, 58% were advised to decrease drinking, and 9% were referred for treatment. In 57 positive patient charts, alcohol use was noted in 33 (58%), and a recommendation in 14 (25%). Newly identified patients had fewer notations than patients with prior alcohol problems. Overall, 6-month alcohol consumption decreased in both AUDIT-positive and AUDIT-negative patients. The proportion of positive patients who consumed more than 16 drinks per week (problem drinking) decreased from 58% to 49%. Problem drinking at 6 months was independent of physician discussion or chart notation. CONCLUSIONS: Resident physicians discussed alcohol use in a majority of patients who screened positive for alcohol problems but less often offered specific advice or treatment. Furthermore, residents were less likely to note concerns about alcohol use in charts of patients newly identified. Finally, a screen for alcohol abuse may influence patient consumption.

OBJECTIVE: To develop a self-report instrument that would provide information about the different levels of the disablement process, and that (1) was suitable for persons with spinal cord disease (SCD), (2) could be completed quickly, (3) could be mailed, (4) had acceptable reliability, and (5) would be clinically useful. STUDY DESIGN: Test-retest using a convenience sample. METHODS: Review of the literature and an expert panel were used to develop the instrument. It was mailed to 49,458 individuals in June 1995 and a second mailing was done in August 1995. A subset of 725 individuals who responded to both mailings was used to examine the instrument's test-retest reliability. RESULTS: The instrument has a 4th grade reading level and has questions on causal disease, disease severity, impairment, activities of daily living (including a self-reported version of the Functional Independence Measure, the SRFM), and resource utilization. Individual item test-retest reliability was high for a mailed questionnaire; all kappa coefficients were near or above .60 and most were over .70. Intraclass correlation coefficient for the SRFM was .90 and internal consistency (Chronbach's alpha) was .96. CONCLUSION: This instrument provides a new, rapid way to obtain information relative to the differing levels of the disablement process

Survivors of torture can present with multiple health consequences, both physical and psychological, which can persist even years after the abuse. The authors developed a multidisciplinary program in the primary care medical clinic of an urban municipal hospital in New York City serving an ethnically diverse population to provide multidisciplinary care to survivors of torture and their families