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Biomedical subjects

A Zácek

Publications and source records attributed to A Zácek.

At least 19 recordsLinked to original sources
PubMed2001

[Will medicine find its identity in the new century? II. Methodology in medical research and the dichotomy of medicine].

Views on causality in medicine are today deeply influenced by philosophy of T. S. Kuhn (paradigm) and K. R. Popper (falsification of hypotheses). Contemporary epidemiological studies, which show the importance of social factors, move scientists in medical research to broaden their traditional positivistic reasoning with the deductive approach in the hypothesis formation, with using sociologic methods and to develop sociobiological research. From the point of falsification theory and alteration of scientific revolutions the causal way in the disease etiology in the permanent seek of the "final" link in the chain of risk factors. Medicine as a humanistic and social science developed dichotomically and asymmetrically. It is now divided and dysfunctional because it is not able to use fully its internal capacity to improve health of the whole population. Search for the identity of medicine is permanent and never ending historical process.

Ethics, Medical↗
PubMed2001

[Will medicine find its identity in the new century? Part I: Medicine--health--disease].

Identity of medicine is determined by its constitutional and essential characteristics that identify it with itself and deliminate medicine from other fields of science. Its basic principle is a new philosophical view on the health and disease and their mutual relationship. To the four traditional models of health the fifth one is added--the continual bio-psycho-social concept: The complex health-disease is a dynamic entity formed by a continuous array of mutually interconnected stays of variously large and measurable health capacity, sensitively responding to stimuli of the social environment. Opinions on the disease causes are expressed in the bio-ecologic model, based on the view of multicausality and multilevel effects of various different factors at all structural levels, among which the principal role has the socio-economic macrosphere.

Disease↗
PubMed2000

[Determinants of health and health policy. Part 3. From intervention of quality of life].

Effectiveness of outputs of a qualified intervention can be valued by several positive criteria corresponding to the "quality of life" conception, which is based on the feeling of the health and contentment. The finding that great differences in the income among different social groups in conditions of the liberal market society correlate with several health and social problems brought about to the hypothesis that the decrease of the differences in the income, accompanied by strengthening of various forms of the social cohesion, civic solidarity, legitimate equality, and ethical justice may substantially improve the health status of the population. The hypothesis has been verified in many epidemiological studies and found to be valid enough for the health policy and far-seeing economy. Analytics of the World Bank recommend to governments primary invest into the health of socially week groups in order to decrease their poverty and to keep social conciliation. World Health Organization (WHO) sets in its new program for Europe called "21 Goals for the 21st Century" that differences in the health status among the European states should diminish till 2020 by one third and within the countries by one quarter at least. Both goals should be achieved by a substantial improvement of the health status of the ill-adapted social groups and by significant improvement of those socioeconomical conditions which may have adverse effects namely on the differences in incomes, education and opportunities for employment.

Czech Republic↗
PubMed2000

[Determinants of health and health policy. Part 2. Classification and effectiveness of the determinants].

Determinants of the health and disease are factors of the human biology, environment, system of health and the human behaviour. For the clinical practice not only their identification, but also their effectiveness becomes important. Modern epidemiological gnoseology serves to this purpose using methods both on the individual and the population levels. At the same time, all indexes of the population's health status respond sensitively to two factors of the social sphere: Differences in the economical standard of the population, classified according the social status or family income, and on the psychosocial markers of the population groups. Relation between poverty and diseases is apparent, while relation between the wealth and health is in the modern societies less obvious. Complicated and comparatively fast sociopolitical, cultural, and psychological changes brought about the feeling that poverty and wealth are not taken absolutely (though differences among the two has risen) but more relatively. People appreciate more the quality of life, which is based more on the psycho-socio-cultural "capital", then on purely materialistic values.

Czech Republic↗
PubMed2000

[Determinants of health and health policies. Part I. Causality in medicine and its modeling].

Causality is the relation between the antecedent and consequence. Association between those two notions represents causal determinacy allowing understanding the subject, and the theory of probability, which deals with supposed contradiction of the chance and necessity. Understanding how health can be impaired enables to precede the disease, to change its natural history and to cure it. Causality in medicine is based on the conception of complex action of biological, psychological and social factors, which may have either positive or negative effects on our health. Empirical data forming basis for the search of aetiology represent a conglomerate of causal and indifferent elements. To identify them, various models are employed (black box, Rubik's cube, Chinese box, model of multiple accidental phenomena and others). Appropriate epidemiological methods enable not only to determine the preference, but also to signalize fallacies of looking for the origin of disease. Permanent problem of the medicine reveals the existence of the objective accident and the uncertainty in the professional decision.

Causality↗
PubMed1997

[The cognitive role of epidemiology and its pitfalls].

One of the most important roles of epidemiology is to seek causes of diseases. The causality in medicine is a difficult philosophical category which requires deep ontological thinking and a thorough methodological preparation. If this condition is not met, various misunderstandings and errors develop with serious consequences for clinical practice. In recent medical literature we find many controversial views which are abused by the press and cause mistrust of the public to medical science and attract patients to the dubious practices of alternative medicine. It is therefore the duty of research workers to pay more attention to modern epidemiological methods and their philosophy. The predominating pluricausal model of risk factors is recently criticized because of its excessive simplicity. reductionism and dualism which separates health from disease. The need arises of a new universal model of health where the dominant position will be held by social environmental, behavioral and psychological aspects. Modern epidemiology needs not only a correct methodology but also a proper theory.

Causality↗
PubMed1997

[Failures, problems and hopes in the transformation of health services. 3. New paradigms in health care and their necessity].

Regulatory interferences of the state can only smoothen frictions in the contemporary model of health care. The new paradigm should be a fundamental breaking point as regards health care and improvement of the health status of the population. Theoretically it is based on the salutogenic concept of health promotion of WHO which shifts the centre of gravity as regards interest and activities from the sphere of disease to the sphere of health. This will involve a long-term education al process to achieve social changes of human behaviour and health culture. A major role in this social phenomenon must be played not only by health workers but in particular by civic initiatives and various public subjects such as foundations, public organizations and other interest groups and societies.

Delivery of Health Care↗
PubMed1997

[Failures, problems and hopes in the transformation of health services. 2. Dilemmas in the development of health services].

In the second stage of the reform it is essential to proceed from problems of financing and rewards to health services and their ethic attributes. The dilemma produced by the increasing demands on availability and standard of services on the one hand and efforts to reduce costs on the other leads to the metaphorical "iron triangle of health care", exposed to intense internal tension. The only possibility how to straighten it, which would weaken the danger of crisis, are strict regulatory measures enforced by the State. The foremost task is to define and specify basic (standard) care. As a possible approach the author mentions the Oregon experiment. He draws attention to the phenomenon of "concentration of costs" in the practice of health insurance companies, calling for a major measure of solidarity.

Czech Republic↗
PubMed1997

[Failures, problems and hopes in the transformation of health services. I. Causes of erroneous decisions in the beginning phases of transformation].

It is generally accepted that the transformation of our health services was not a success. The reasons of failure were political and professional. Our country was too long isolated from the West and we lacked experience of countries where the reform of health services had been underway for some time. At the onset of the reform three basic findings were underrated or omitted: 1. Health needs are infinite and the resources of the health services have limits which cannot be trespassed. 2. There is no simple linear correlation between financial expenditure and the health standard. 3. The main problems of health care cannot be mastered by mere deetatization, privatization and a free market.

Czech Republic↗
PubMed1994

[Ethical problems in health care].

Changes in the scale of values associated with society entering plural democracy caused as regards conceptual problems of health care some ethical doubts and objections. In the author's opinion the most important ones are: problems on the essence of health and mission of health policy, responsibility for health care, nature of health services under conditions of market economy, problems of the interpretation of right to health, health requirements and the importance of equity in advanced cultural societies.

Ethics, Medical↗
PubMed1993

[Hospital productivity and methods of evaluating utilization of beds].

The authors define the hospital (or departmental) productivity the criteria of which are the use of the hospital capacity: the average length of stay, the occupancy ratio, the turnover interval and the turnover. The authors describe the construction of a nomogram for the graphic evaluation of the position of all four indicators. They submit a formula for calculation of the global "index of hospital productivity". They consider the possibility to increase hospital productivity in particular by reducing the length of stay and turnover interval. They draw attention to the influence of external circumstances on hospitalization and the necessity to evaluate indicators of productivity in association with efficiency, effectivity and quality of hospital care.

Bed Occupancy↗
PubMed1990

[How urgent is the need to reform medical education?].

Many proposals regarding reforms of our health services pertain to the organization, financing and material and technical equipment of health departments. But many people forget that the causes of inadequate meeting of health needs of individuals and society are much more profound. The present article draws attention to the urgent need of reforms of the medical curriculum at medical faculties and postgraduate institutes. The core of the problem are rigid forms of teaching and the absolute predominance of biomedical and technological aspects of training over psychosocial and sociooecological aspects of training of future doctors. The submitted paper refers to attitudes and recommendations of WHO and other international organizations concerned with medical training.

Czechoslovakia↗
PubMed1990

[Health care planning strategies and the need for demographic and operational research].

Planning of health care is an indispensible prerequisite of social and economic development of every state. The European version of the WHO programme Health for All is suitable planning model. The programme is systematically conceived, it states general fundamental priorities and the sequence of the implementation of tasks to attain precisely defined goals. Its implementation calls for epidemiological, sociological and operational research in order to study the health status of the population, risk and protective factors and the function of the system of health services. A uniform overall national programme of health care should be elaborated and our nation-wide health programmes should form an integral part in it.

Health Planning↗
PubMed1989

[Perspectives in the development of health care in Czechoslovakia].

The finding that the health status of the population is shaped in particular by social and cultural conditions is accepted not only by health workers but also by political and executive authorities of the State. For the further development health care of the people is of revolutionary importance. If society will find adequate political will to take the appropriate measures, we may expect radical changes in all spheres of national economy, social life, science and culture. The basic demand is that health workers must acquire new sociomedical thinking which supplements and at the same time replaces the out-dated biomedical pattern. Structural changes will pertain in particular to mechanisms and organizational measures which will ensure the implementation of the health policy beyond the framework of the health services. In the system of health services we may anticipate that the centre of gravity in health care will shift from the traditional hospital to out-patient facilities with emphasis on the newly conceived function of primary health care. Training of health workers will have to be modified to the effect that graduates will be better prepared to meet actual needs of health care focused on prevention, economy, effectiveness and quality. It will be necessary to create favourable conditions for the development of socio-ecological, epidemiological and operational research. The democratization of health care will call for greater interest and initiative on the part of the public as regards collective and individual health. Our partial health projects should be re-arranged into a single comprehensive nation-wide programme which will include all spheres of health care in the sense of the WHO programme in its modification for Europe.

Czechoslovakia↗