BigFatKen
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Infectious DiseasesI like to keep up with what is going around the world in Infectious Diseases. Lots of bad things like
Acinetobacter baumannii is a Gram-Negative that I got a VA but it did not quite kill me. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442836/
Here is today's update:
Gun violence is a complex biopsychosocial disease and as such, requires a multidisciplinary approach to understanding and treatment. Framing gun violence as a disease places it firmly within medical and public health practice. By applying the disease model to gun violence, it is possible to explore the host, agent, and environment in which gun violence occurs, and to identify risk factors to target for prevention. This approach also provides an opportunity to address scientifically inaccurate assumptions about gun violence. In addition, there are many opportunities for medical communities to treat gun violence as a disease by considering and treating the biologic, behavioral, and social aspects of this disease. The medical community must answer recent calls to engage in gun violence prevention, and employing this model of gun violence as a biopsychosocial disease provides a framework for engagement.
Gun violence is a pervasive public health burden in the United States. Annually, over 36,000 Americans die from firearm-related events; tens of thousands are injured.[1] The medical community has periodically called for framing gun violence as a public health/medical issue.[2–9] Given the impact of gun violence on health and longevity,[10] others have suggested that physicians have a moral obligation to address gun violence.[11,12] More recently, others have called upon physicians to integrate firearm-related education about safety with their patients.[13]
Calls for engagement have increased with multiple physician organizations calling for action.[2,14] In much the same way that human immunodeficiency virus (HIV) rates grew unchecked until we began to acknowledge that it was a biopsychosocial disease that could be prevented and controlled, and scientifically we moved past the social stigmas of a disease first recognized as largely affecting homosexual men, gun violence will continue unchecked until we invest in research to discover effective means to reduce it. To fully engage physicians and other sectors of the healthcare community, we need to frame gun violence as a biopsychosocial disease.[12] We know that gun violence follows predictable patterns just like infectious diseases and other illnesses.[15]For example, young African-American males are at increased risk of firearm-related homicide, while older White males are at increased risk for firearm-related suicide. Through an understanding of the risk factors for a disease, we can identify means of control and prevention.
The disease model approach was first advanced in the 19th century and continues today. With a science driven understanding of disease etiology, physicians and other civic leaders were positioned to discover vaccines, thus changing the environments that breed the vectors of illnesses, while identifying high-risk groups for preventative interventions– all driven by the science of discovery. We are seeing this unfold today with the Zika virus,[16]and the prevention strategies of other communicable diseases such as tuberculosis and HIV that continue to benefit from the rigorous application of the disease model. By identifying and understanding the disease agent, its vector of transmission, and the high-risk hosts and environments, all sectors of civil society – healthcare, public health, businesses, schools, fire and police agencies– can work in concert to institute interventions that reduce morbidity and mortality. These interventions may prevent exposure to the agent that causes disease, reduce the chance of becoming ill if exposed, or limit the damage after the disease is contracted.
Scientific investigations have advanced the disease model to include other causes of cellular/organ damage from a variety of etiologic agents.[17] For decades, clinicians and public health professionals have been trained to understand the definition of disease as having four components: etiology, pathogenesis, morphologic changes, and clinical significance. [17] We have learned that the etiologic agents of diseases are categorized into biologic and physical agents that interact with cells and organs, resulting in disruptions of cell walls and the release of substances that cause additional destruction.[18]For example, with the Ebola virus disease, the pathogenesis occurs over days and can manifest up to 21 days after exposure. The virus begins to replicate and results in morphologic changes in cells/organs that manifest as a constellation of symptoms, resulting in nausea, vomiting, and diarrhea, leading to dehydration, organ failure and death.
Analogously, the kinetic energy from a bullet is the physical agent of gun violence. The kinetic energy imparted by the speeding mass of the bullet results in the tearing of cellular membranes, leading to edema, fractures, and bleeding, resulting in organ failure, shock, and death. The energy (KE=1/2MV2), is transmitted to the host/patient from the bullet – penetrating the skin, entering the body, and transmitting the energy, leading to temporary and permanent cavity formation, and a sterile injury to the patient.[18,19] The pathophysiology of this disease has received limited examination because the agent (kinetic energy) causes destruction so quickly (less than 0.1 sec).[20] The high-speed video camera is the "microscope" for this rapidly occurring disease. It is through this "lens" that we can document the temporary and permanent cavity formation that is the hallmark of the biology of this disease.[19–21] This dramatically brief pathophysiology limits acute interventions during the release of kinetic energy and is distinctive since diseases from other agents, such as viruses and bacteria, clinically develop over days or weeks.
By framing gun violence as a biopsychosocial disease,[22] it engages the healthcare community of physicians and nurses, complements the necessary multidisciplinary approach to advance our scientific understanding, and informs host, agent/vector, and environmentally-focused interventions beyond the immediate biology of fractures, bleeding, and edema. This is critically important since preventing and controlling gun violence will not occur to any significant degree until we begin to approach it in a manner similar to controlling other biopsychosocial diseases such as HIV. One immediate benefit of framing gun violence as a disease is the opportunity to address misleading/limiting statements as scientifically inaccurate, yet repeated over and over again. One of the most common of these is: "Guns don't kill people, people kill people."
The disease model provides us with accuracy: the bullet and its kinetic energy shreds, tears and destroys cells, and damages organs, leading to death and disability. While the behavioral health issues that result in a person pulling a trigger and releasing the energy need to be better understood, first and foremost we need scientifically accurate statements that advance the necessary, challenging discussions. By recognizing that bullets kill people, the gun, which carries the bullets, becomes a necessary focus of intervention. One such strategy would be to limit the rate of the release of bullets by, for example, banning bump stocks or automatic weapons, or by reducing the amount of potential energy the gun can carry (magazine capacity). Without this framing we will be limited to education of our patients[13] or continue to be stuck, mired in debates that do not advance scientific understanding, but only entrench positions. We limit progress related to gun violence by not addressing the environment and the social context and psychological antecedents and outcomes of this disease that affect patients, families and communities.
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https://www.medscape.com/viewarticle/905840?src=wnl_edit_tpal&uac=312637AZ&impID=1868804&faf=1
