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The triumph and tragedy of James Baxler Bean, MD, DDS (1834-1870).

In 1863, James Baxter Bean, a Southern physician and dentist, invented the interdental splint. This device was used to treat hundreds of Confederate soldiers who had received gun shot-related facial and jaw injuries during the Civil War. Made of vulcanized India-rubber, the splint provided a dramatic breakthrough in the treatment of maxillofacial wounds. In an Atlanta, Georgia hospital, Dr. Bean utilized his invention by establishing the first ward devoted exclusively to the treatment of jaw fractures. He also invented an apparatus that manufactured and administered nitrous oxide. Additionally, Bean's groundwork in casting aluminum as a denture base material led to Taggart's later invention (in 1907) of the casting machine. After the Civil War, Dr. Bean became a highly successful dentist, practicing in Baltimore, Maryland. In the fall of 1870, at age 36, Bean, representing the Smithsonian Institution in Washington, D.C., traveled to Europe to gather geological specimens. A short time after arriving, Bean decided to climb Mont Blanc with ten other men. The entire group perished in a raging 8-day snow storm on the mountain peak. This tragedy, a compelling drama, is legendary in the annals of mountaineering history. After Dr. Bean's passing, his wife lost her sanity and subsequently died. Later, the death of the couple's only child, Chapin, sadly ended the family line. Although his life was cut short, Bean's contributions to dentistry have been significant and far-reaching.

Anesthesia, Dental↗

[Self-esteem of nursing undergraduate students].

UNLABELLED: This study evaluates the self-esteem of undergraduate students of nursing, that through a workshop developed mechanisms for improving their self-esteem, considering that this is the most propitious time for students to multiply health care actions. METHODOLOGY: the research was carried out with 156 undergraduate students of the third year. Socio-drama techniques of Neurolinguistics were used and the evaluation was done according to Minayo. It was possible to observe that students usually confuse self-esteem and self-image, and that both are stereotyped for for men and women. As nurses are always worried about the client/patient's life quality, they neglect themselves. In this case, the Workshops were essential for the students to rescue interior knowledge about themselves, and to realize that in order to take good care of clients/patients, they must be physically and psychologically healthy.

Adult↗

Maria tells her story.

As evidenced by the Latino Health Task Force Report, Latinos living in North Carolina face numerous challenges when seeking healthcare services. Those of us who have had the privilege to serve Latinos in clinics and hospitals have been witnesses to the drama that unfolds every day for these families. Navigating through our healthcare system can be a very taxing process for Latino immigrants. In order to fully understand these difficulties, sometimes it's best to let the people tell their story. It is with this thought in mind that we bring you this commentary piece. María and Jesús live in North Carolina. María tells her story to a nurse who speaks Spanish. Although these characters are entirely fictional, the events described here--and many others like them--have taken place all across the state and the country. Any similarities to actual people living or deceased is purely coincidental.

Accidents, Occupational↗

St. Mary's Hospital, rescued climber meet reporters as HIPAA rules begin.

St. Mary's Hospital, Grand Junction, Colo., is a regional hospital whose PR team is accustomed to media exposure. Just as tehy were instituting the patient privacy rules of HIPAA, a true-life reality drama landed on their doorstep. Aron Ralston, a 27-year old experienced mountain climber, became the hospital's highest profile patient and attracted worldwide media coverage after courageously rescuing himself from a near-disaster.

Adult↗

The many-voiced cultural story line of a case of diabetes mellitus.

An ethnographic approach is used to conduct and describe my research into a case of chronic illness and to assist the family physician's interventions. What at first appeared to be a frustrating, difficult-to-control case of diabetes mellitus was later revealed to be an intricate drama involving multiple voices and issues: marital, life stage, family, religious, occupational, regional, economic, and physician family-of-origin. Questions such as who has the disease?, what is the disease?, what keeps the disease going?, who is the patient?, and who is the clinician? are explored in the context of this case. The case was "solved" when the loss and sadness of aging was discovered and accepted during a cathartic session involving the diabetic patient, her husband, their family physician, and myself, a consultant.

Aging↗

Fight for survival: the life of a Hansen's disease sufferer through his correspondence with Adolpho Lutz.

This project presents the complete set of letters between the family of a Hansen's disease (leprosy) sufferer in the state of Maranhão, in the Northeast of Brazil, and the doctor and bacteriologist Adolpho Lutz. For more than twenty years Fabricio Caldas de Oliveira and Numa Pires de Oliveira, father and son, exchanged a steady flow of letters with the scientist in pursuit of a cure for the disease that had assailed Numa since childhood. The 24 letters compiled here paint a unique portrait of the medical and social drama confronted by this family, and the results of the use of chaulmoogra oil and other medications in their search for alternative treatments.

Brazil↗

[Teratogenesis and medication induced fetal toxicity].

The administration of pharmacological treatments during pregnancy always arouses concerns, shared both by the medical body and the general public. The drama of thalidomide, the main cause, has been followed by a number of efforts to develop some knowledge on the reality, nature and frequency of risk of malformation and foeto-toxicity, in particular from medications. A more rational approach to pharmacotherapy in the pregnant woman has come about following a position that was less supported and more alarmist. The principal idea that emerges consists of defending a more realistic evaluation of the risk:benefit ratio of pharmacotherapy in a sick pregnant woman, against the temptation of not treating or giving a maladaptive treatment. The second notion, essential in chronic pathologies, consists of supporting the efforts of multidisciplinary teams working in the pharmacotherapeutic management of pregnant women, to avoid errors of strategy that may be both medical and human.

Abnormalities, Drug-Induced↗

[Serotonin dysfunctions in the background of the seven deadly sins].

The symbolic characters of the Seven Deadly Sins can be traced from time to time in the cultural history of human mankind, being directly specified in certain artistic products. Such are, among others, the painting entitled "The Seven Deadly Sins and the Four Lost Things" by Hieronymus Bosch and the poems Divina Commedia and The Foerie Queene by Dante Alighieri and Edmund Spenser, respectively. However, there are several paragraphs referring to these behaviours of the Seven Deadly Sins in the Bible and in the dramas of William Shakespeare. The objective of the present review is to propose that dysfunctions in the central serotonergic system might be involved in the neurobiology of these 'sinful' behaviour patterns. Evidences indicate that behaviour traits such as Accidia (Sloth), Luxuria (Lust, Lechery), Superbia (Pride), Ira (Wrath, Anger), Invidia (Envy), Avaritia (Greed, Avarice), and Gula (Gluttony) can relate to the functional alterations of serotonin in the brain. Results of biochemical and molecular genetic (polymorphism) studies on the human serotonergic system (receptor, transporter, enzyme), findings of functional imaging techniques, effects of depletion (or supplementation) of the serotonin precursor tryptophan, data of challenge probe investigations directed to testing central serotonergic functions, alterations in the peripheral serotonin measures (platelet), and the changes in the CSF 5-hydroxy-indoleacetic acid content indicate such serotonergic involvement. Furthermore, results of animal experiments on behaviour change (aggressive, dominant or submissive, appetite, alcohol preference) attributed to serotonin status modification and the clinically evidenced therapeutic efficacy of pharmacological interventions, based on the modulation and perturbation of the serotonergic system (e.g. selective serotonin reuptake inhibitors), in treating the 'sinful' behaviour forms and analogous pathological states reaching the severity of psychiatric disorders (depression, sexual disturbances, social phobia, impulsivity-aggression, obsessive-compulsive and related spectrum disorders, paranoid jealousy, eating disorders) all strongly suggest the possibility that brain serotonin dysfunctions might underlie the neurophysiology of the Seven Deadly Sins.

Behavior↗

Protection in eye of beholder. Courts send mixed messages about the sanctity of medical files in the face of federal subpoenas for patients' abortion records.

With three trials under way on lawsuits challenging the Partial Birth Abortion Act, hospitals have been dragged into a drama involving medical-record privacy. It's providing a lesson on how little protection HIPAA offers in court. "We sought to find a way to produce those records in a way that would not embarrass our patients," said a counsel for the University of Michigan Hospitals and Health Centers, left.

Abortion, Illegal↗

Alcohol consumption in television programming in three English-speaking cultures.

Previous research relating television advertising and alcohol consumption indicates no meaningful relationships. This study focused on observed drinking behaviour in comedy, soap opera, drama, and police/detective programmes produced for British, American and Canadian television. Results indicated British television fiction had three times the amount of alcohol consumption seen in either American or Canadian programming. In spite of this more frequent portrayal of alcohol consumption, examination of World Drinking Trends and other alcohol-related statistics (i.e. cirrhosis and alcohol-related auto accidents) indicated no greater level of alcohol misuse in the U.K. than in Canada or the United States. In fact, available statistics indicate significantly lower rates of liver cirrhosis in Britain as opposed to Canada and the United States. Hypotheses regarding the absence of relation between fictional and actual alcohol consumption were discussed.

Advertising↗

[Anxiety, nostalgia and melancholy. A few remarks on psychoanalysis and tango].

Our work is based on the application of psychoanalytic techniques, in order to unveil this cultural phenomenon called tango, related with sexuality and unconscious processes. As a way of introduction, it deals with a brief theory of the birth of tango, the possible terminological source of its name, its main creators and interpreters, as well as the chronological classification into the first wave tangos, Guardia Vieja, and the newer wave tangos, Guardia Nueva. The former ones were awash with festive themes of the centennial years, expressed in behaviors that denote sexuality and love, whereas the latter ones, expose the great bewilderment of the thirties' crisis, due to the imminent downfall of the country, the denunciation of materialism, the crumbling of ideas; which led up to feelings of utter pessimism, loneliness and abandonment. From this point onwards, through the use of techniques provided by psychoanalysis applied to tango lyrics, we are able to unravel the unconscious processes of the drama of its characters; the immigrant, hopeful and at same time nostalgic for the loss of his mother country; the porteno -urban man from Buenos Aires city- who, overwhelmed by immigrants, has to give way to the new compatriots; the inland inhabitant, who was dragged to the city because of the new conditions of rural work; and finally the conventillo, tenement house, as a melting pot that fulfilled the integration of these groups. Like in a painter's palette, which contains various colors and shades, the interpretations about nostalgia, grief and loneliness become apparent, along with the father-son rivalry, the conflict with the absent mother, the relationship between sexes, male chauvinism, infatuation, identity, the fear of death, the rebirth to a new life, the passage from gaucho to guapo, from a shrewd horseman to a daring, bullying braggart.

Anxiety↗

Hindrances to family planning program: findings from Banke, Nepal.

Reducing population growth through programs is a high priority for many developing countries. Why particularly in the rural regions of these countries, do these initiatives fail? Using a case study of a recent initiative in rural Nepal between 1998 and 2002 as an example, this opinion piece discusses possible reasons for such failure and recommends that a broader strategic approach is necessary, particularly in relation to empowering women in these communities. Banke district, Nepal, is mainly rural, consisting of 47 villages. Scarcity of family planning provisions is a dominant problem in most parts of the district. District Public Health Office (DPHO), the major family service provider lacks resources and technical capabilities. In recent years, non-government organizations (NGOs) have been collaborating and coordinating their efforts with DPHO in order to cover the larger section of the district population. A local NGO called Banke Mahila Arthick Swawlamban Sangathan (BMASS) provided family planning services in 5 of the 47 villages of Banke district, Nepal, from 1998 through 2002. Outreach activities and clinical services were the two major components of BMASS family planning program. Outreach activities included door-to-door/mass counseling, street drama, and condom distribution. Clinical services that included counseling, testing, temporary sterilization, and referrals for permanent sterilization were provided through a centrally located static clinic and mobile clinics. BMASS family planning program had almost no impact in the target villages. There was no significant increase in contraceptive use, people's motivation to limit fertility, and number of people preferring a smaller family size. The contraceptive prevalence rate increased by less than 2% after 2 years of family planning program intervention. More than 80% of the family planning clients were reported to have discontinued contraceptive use within six months. The mean age of women at the time of first child delivery (16.2 years), total fertility rate (six children per woman), and the birth intervals (13-18 months) were reported to be the same for both periods: before and two years after family planning program intervention. Further assessment of the local factors revealed that women's lack of control over fertility and higher number of desired children could have hindered the community's response to BMASS family planning program. In the target villages a woman's fertility is dependent upon the preference of husbands and in-laws. The women in general are not empowered to voice their opinion with regards to delaying fertility, spacing child-births, and limiting the number of children to be born to them. Higher number of desired children in the target villages is the outcome of low cost of child rearing and high benefits from the children. Children not only contribute significantly in household economy and provide old age security to their parents, but also consume less. To be effective, family planning programs need to be integrated into broader societal reforms that address rural economic development and the role of women in society.

Journal Article↗

Provider class actions against MCOs: the march toward trial.

In re Managed Care has been one of the most protracted, if not the most significant, class-action lawsuit against the managed care industry. After more than five years, the drama is intensifying. Many large players have settled the case, but it appears that the remaining defendants are willing to let a jury decide the validity of managed care practices and whether MCOs have engaged in racketeering.

Capitation Fee↗

The medical school curriculum at University Malaysia Sabah.

The integrated curriculum at the newly established medical school at University Malaysia Sabah is examined from aspects of the objectives of the medical training in achieving development of the required skills and knowledge as well as personal and professional development. The teaching is spread over five years with an emphasis on basic medical sciences in the first two years although the students are exposed to clinical skills right from the onset. A gradual transition to emphasis on the acquisition of clinical skills occurs from the third year onwards. However, community medicine and professional development are incorporated into the programme from the first year and are carried over to the final year. Although there are examinations to be passed in all the courses taught every semester, with a Cumulative Grade Point Average (CGPA) of 3.0 (65 percentile score) and the candidate has to pass all the examinations in that year to clear a particular year, two professional examinations are administered, one at the end of the Third Year (end of the Phase I of the Medical Programme) and another at the end of the Fifth or Final year (end of the Phase II of the Medical Programme). Programmes for Postings, Shadow House Officers (SHOP) and Population Health are also incorporated into the curriculum. Delivery of the courses involve Lectures, Self-Learning Packages (SLP), Small Group Discussions (SGD), Seminars, Debates, Dramas, Video clips, Special Study Modules (SSM), Computer-Aided Instruction (CAI), Problem-based Learning (PBL), Problem-solving Sessions (PSS) and Clinical Skills Learning (CSL). The examination involves elements of continuous assessment and final end of semester or end of phases I and II Professional Examinations. Practical may involve Objective Structured Practical Examinations (OSPE) and/or Objective Structured Clinical Examinations (OSCE). They may also involve viva voce and/or short and long case presentations and assessment of log book entries.

Clinical Competence↗

[Psychotherapy of trauma-related borderline pathology].

Borderline pathology originating from trauma is characterized by increasingly severe borderline and comorbid symptoms, poor psychosocial function, and poor prognosis in comparison with borderline patients who have never undergone such traumatic experiences. Instead of psychodynamic therapy, other forms of psychotherapy, such as cognitive-behavioral approaches are offered helping to stabilize the patient's life and improve his or her ways of coping with stressors. Trauma recovery depends on appropriate timing and careful preparation, where the patient first must learn to trust the therapist and gain some ego-strength. Failure to be properly prepared can lead to the escalation of former self-destructive defenses once used against the trauma. Typical transference-counter-transference dynamics can be conceptualized as episodes in a drama involving four principal characters: a victim, an abuser, an idealized rescuer, and a betrayer mother. Role enactments oscillate in various complementary pairings between patient and therapist during the course of therapy.

Borderline Personality Disorder↗

[Mental illness and stigma or how to become mentally ill for life.].

In this article mental illness is presented in a sociological perspective, giving prominence to social-interaction factors which, in many cases, are responsable for the permanence of this type of illness. Its thereotical base comes !form the psychology of social-interaction developped by G.H. Mead and his disciples. This perspective defines the social human being as derived from successive interactions, beginning, at birth, with maternal contacts and extending progressively to the entirety of the members of the community of which the individual is a part. This interactional network is comprised of messages, of responses, and of expectations which make up the norms and values which in turn from the basis for the distribution of roles and statuses- From these roles and statuses derive the behaviours acceptable to a given collectivity. Among other theoretical developments, interactionist sociology gave birth to formulations on deviance which became known, in american terminology as "labelling theory". In the case of mental illness many sociologists interested in the phenomenon have studied it, using the framework elaborated by the proponents of this approach to deviance. Thus, rather than considering the deviant as abnormal in himself, deviance is viewed as a process; that is, as the result of a series of interactions confronting the individual who is not, or does not behave like the collectivity as a whole and the milieu in which he lives. When the reaction of the entourage is negative, the so-called deviant is subjected to sanctions such as avoidance, rejection, exclusion, confinement, etc... This process terminates generally in stigmatization which wraps the deviant in a label from which he will probably never free himself. The studies cited demonstrate this interactional process at different stages of mental illness, these being; d) at the point of medical diagnosis, b) during hospitalisation, c) on leaving We psychiatric institution, d) and after the return to society. The conclusion leads to an appreciation of the drama experienced by psychiatric ex-patients, for most of whom the label "mentally ill" constitutes an apparently irreversible stigmatization.

English Abstract↗

[A tuberculosis project in Ecuador].

OBJECTIVE: Determination of the frequency of pulmonary tuberculosis in an Indian community in Ecuador among symptomatic patients and contacts of patients with tuberculosis. Pulmonary tuberculosis was defined as the presence of acid fast rods in sputum. SETTING: Pontificia Universidad Catolica del Ecuador, Quito, Ecuador. DESIGN: Sputum samples were collected with the aid of an educational drama. About 5000 persons were informed on tuberculosis by this performance. The sputum samples from 241 persons were examined for presence of acid-fast rods with a direct Ziehl-Neelsen (ZN) stain and a ZN stain after concentration of the sputum. If ZN stain was negative, the sputum was cultured on Löwenstein-Jensen medium or on Coletsos medium. The Löwenstein-Jensen medium was past the expiration date. RESULTS: Bacteriological examination of the sputum samples from 241 patients and controls brought to light 65 (26.9%) individuals with acid-fast rods in the sputum. Forty per cent of the affected patients were between the ages of 20 and 34. Investigation of 82 contact persons revealed 19 (23.2%) positive cases. The results of culturing of the sputum samples were disappointing: only 6 of 152 (3.9%) samples showed growth of acid-fast rods. CONCLUSIONS: The frequency of pulmonary tuberculosis (as defined by the presence of acid fast rods in sputum) is high in the community investigated, much higher than the official data on the prevalence of tuberculosis indicate. It is important to investigate contacts of patients with pulmonary tuberculosis to trace a source and to trace new cases.

Adolescent↗