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Max Linde, MD, a Luebeck ophthalmologist and patron of Edvard Munch.

Ophthalmologist Maximilian Linde (1862-1940) had a passion for contemporary art and owned one of the most important private collections in Europe. He first met little known Norwegian expressionist Edvard Munch in 1903, recognized special talent, and welcomed him into his family. With Linde's encouragement, patronage, and friendship, Munich became one of the most important artists of his time. Many of Munch's works were commissioned by Linde and many featured Linde and his family as subjects.

Germany↗

Historical vignette: a life with poxviruses and publishers.

Although I started science investigating the physical anthropology of Australian aboriginals and then spent six years in the Australian Army during the 1939-45 war, largely working on malaria control, the poxviruses have been the focal point of my research--at the bench, in the field, on committees, and in front of my word processor. I have had a relatively short period as a scientist at the bench, just over twenty years out of the sixty years since I graduated. For the last thirty years the pipette has been replaced by the pen and the word processor, and contacts with publishers have become an important element in my life. My pilgrim's progress, from mousepox through myxomatosis to vaccinia and then smallpox, has been helped by what can only be described as good luck, coming in many guises. I have been fortunate in many ways; in my father and mother and the genes and family life they gave me; in my wife, who was an immense source of support until her death in 1995; in the people whom I met during the Second World War; and in my close association with three great scientists, Macfarlane Burnet, René Dubos, and Howard Florey. I had the good fortune to be appointed, as a young and inexperienced virologist, to one of the best research jobs in the world, as a professor in the Australian National University. I have been very lucky in having had the opportunity to exploit a series of scientific gold mines; in turn, malaria, during the War, then mousepox, an unexploited virus because its use was forbidden in the United States, then, after a brief flirtation with mycobacteria, myxomatosis, an unparalleled natural experiment of evolution in action, and finally the most impressive achievement in public health in world history, the global eradication of smallpox. My last job in the University before retirement provided me with the opportunity to do something about the most important problems confronting humankind: the degradation of the environment, driven by the explosion in human numbers and their ever-growing use of resources. Each of these activities has provided opportunities to establish and maintain close friendships with scientists all over the world.

Animals↗

Analysis of hospital charges for cerebral infarction stroke inpatients in Beijing, People's Republic of China.

OBJECTIVE: Stroke is a heavy economic burden on the individuals, society and health services in China, where health expenditure is rising rapidly. The purpose of the present study is to examine health services and demographic factors associated with inpatient charges for cerebral infarction in China, focusing on hospital charges of insured and uninsured patients. METHODS: The study subjects were 545 patients with a principal diagnosis of cerebral infarction stroke who were discharged from the China-Japan Friendship Hospital from January 1, 1997 through December 31, 1998. Demographic, clinical and administrative data were retrospectively collected from the medical record and financial database. The influence of social and medical factors on total charges was analyzed with stepwise multiple regression model. RESULTS: Of 545 subjects, 429 (79%) were the insured patients and 116 (21%) were the uninsured patients. Length of hospital stay (LOHS) for the insured patients (median, 32 days) was significantly longer (P<0.001) than that for the uninsured (median, 23 days). The hospital charges per discharge for the insured was significantly higher (geometric mean, 10407 yuan) (P<0.0001) than that for the uninsured patients (geometric mean, 5857 yuan). With stepwise multiple regression, factors associated independently with the hospital charge were: longer hospital stay, insurance status, increased number of head magnetic resonance imaging (MRI) and computerized tomography (CT), infection in hospital stay, and more severe condition of stroke. CONCLUSIONS: Inpatient charge for cerebral infarction stroke was positively associated with being the insured. The findings suggest an overuse of health care resources in insured patients and limited use of resources by those who are not.

Adult↗

The role of cultural and social factors in the cause of addictive disorders.

For many centuries, generations of young people were protected from the early onset of addictive disorders. Although addiction to drugs and alcohol had been well known for centuries, widespread addiction has occurred only in recent centuries. Because the human gene pool or human biochemistry did not likely change suddenly to produce this result, social and cultural factors likely have produced widespread addiction. From another perspective, the sociocultural factors that once protected our societies against widespread addiction may have become weakened or inoperative. Our social institutions--our families, schools, religions, neighborhoods, and governments--no longer protect us and our young from addiction as they once did. The failure of traditional social institutions to protect us from addiction does not mean that we must seek drug panaceas only in nonsocietal venues, such as medications and psychotherapies. Rather, we should look to those elements of our institutions that have failed us and seek to bolster them. A gradually evolving body of literature on this topic demonstrates that institutional changes can serve to reduce widespread addiction among us. Moreover, these changes can be implemented at many levels: within our families, schools, friendship groups, workplaces, churches, neighborhoods, and legislatures.

Adolescent↗

The adolescent. Athletics and development.

An appreciation of adolescent growth and development is essential to the understanding of problems faced by the adolescent athlete. Early adolescence (ages 10-15 years) can be characterized as the body period. Physical growth is genetically determined and can be influenced by disease, injury, and nutrition. Early maturers are subject to adult expectations which may lead to either failure or excessive acclaim. Middle adolescence (ages 15-18 years) is the sexuality period, with special emphasis on gender identity. Friendships are critical, and athletics can be a focal point for showing love and affection without social fear. Late adolescence (ages 18-22 years) is the separation period. Young people with athletic skills leave home to face greater athletic and academic pressure and competition in college. Adjustment to this final adolescent period is achieved through learning to lose as well as win with grace and dignity.

Adolescent↗

Contrasting lives, contrasting views? Understandings of health inequalities from children in differing social circumstances.

Children's differing socio-economic, cultural and familial circumstances and experiences are part of the pathways implicated in health and illness in adulthood. However, in the existing, mainly survey based, work children's own voices tend to be absent and adult-defined data about health and illness accumulated. Little is known about the social and cultural processes, in children's very different childhoods, which underpin and ultimately constitute these epidemiological findings. This paper reports findings from a qualitative study examining the socio-economic and cultural contexts of children's lifestyles and the production of inequalities in health, carried out in a large Scottish city. Two rounds of semi-structured interviews, using a range of child-friendly techniques (photographs, drawings, vignettes), were carried out with 35 girls and boys aged 9-12 years living in two contrasting but contiguous areas, one relatively advantaged and one relatively disadvantaged. Thirty of their parents were also interviewed and community profiling and observational work undertaken. Children and parents described often starkly contrasting lives and opportunities, regularly involving material differences. However, children appeared to locate inequalities as much in relationships and social life as in material concerns; in this their direct experiences of relationships and unfairness were central to their making sense of inequality and its impact on health. Although children from both areas highlighted several different inequalities, including those related to material resources, they also spoke of the importance of control over their life world; of care and love particularly from parents; of friendship and acceptance by their peer group. Many children challenged straightforward causal explanations for future ill-health, privileging some explanations, such as psychological or lifestyle factors. The accounts of children from both areas displayed considerable resilience to and downplaying of the effects of both relationship and material inequalities; also showing how familial and personal challenges, such as bullying, divorce, learning difficulties, cut across structurally based differences.

Attitude to Health↗

Contexts and patterns of men's commercial sexual partnerships in northeastern Thailand: implications for AIDS prevention.

Results of an exploratory research project elaborating the contexts, patterns and specific scenarios of the commercial sexual activity of northeastern Thai men are reported. Data were collected using face-to-face surveys, focus groups, key informant interviews and observations in 32 northeastern villages (n = 744 men), 18 migrant labour camps housing sugarcane workers (n = 219 men), and five cattlemarkets in northeast Thailand. Fifty percent of married men and 43% of single men had visited female sex workers (FSW). Female sex worker visits occurred primarily prior to marriage, though 13% of married men had purchased sexual services within the past year. Nonmarital sexual activity was set within the socio-cultural frameworks of poverty, circular migration, a large commercial sex sector, and a belief system about men's sexuality and men's and women's gender roles. Sexual services were typically purchased as part of friendship group partying (paiy tiaow) and generally included heavy alcohol consumption. The most common scenario for visiting FSWs involved brothels, though cattlemarkets, festivals, and migrant labour situations were also scenarios for FSW contact. These each had unique characteristics that affected the likelihood that condoms would be used. The further the specifics of a scenario (as evaluated by men) diverged from those of brothel contact with an FSW, the less likely men were to identify this as having the potential for HIV transmission and the less likely they were to use a condom. AIDS prevention campaigns must be developed that are sensitive to the socio-cultural framework, contexts and specific scenarios within which nonmarital sexual contacts occur.

Adolescent↗

Family responses to HIV/AIDS in Mexico.

This paper presents findings from a qualitative study of household and community responses to HIV/AIDS in Mexico. Fieldwork took place in two contrasting settings: (a) Ciudad Netzahualcóyotl, a socially marginalized urban community and (b) the homosexual community of Mexico City, a sexually marginalized social network. 113 in-depth interviews were conducted with people with HIV/AIDS, their relatives and members of their social networks. This paper describes findings from interviews conducted with family members of persons with AIDS. Four stages of response are identified and characterized within each community: (i) life before AIDS, (ii) life during the discovery of AIDS, (iii) living with a person with AIDS and (iv) surviving those who have died from AIDS. The social marginalization of both communities is central in explaining how families respond to the disease. In Ciudad Netzahualcoyotl, social support derives from a local culture of kinship. In the gay community, on the other hand, solidarity arises out of friendship. Between social support and discrimination, many more "ambivalent" behaviours (neither fully supportive nor discriminating) are displayed by family members and friends. Fear, pre-existing family conflicts and prejudice nurture these negative responses. Family responses and the processes to which they give rise, also differ depending on whether or not a male or female household member is affected. Policy recommendations are made concerning how best to promote positive family and household responses to persons with HIV/AIDS and how to inhibit negative ones.

Acquired Immunodeficiency Syndrome↗

A two-stage model of peer influence in adolescent substance use: individual and relationship-specific differences in susceptibility to influence.

A two-stage model of peer influence was proposed. The model served as a framework for examining individual and relationship-specific differences in susceptibility to influence. The two stages are (1) the acquisition of a peer context and (2) conforming to the behavior of a peer. Data from a four-wave longitudinal study were used to assess (1) the initial selection of cigarette- and alcohol-using peers and (2) influence from peers. Relationship factors and variables identified as risk factors for substance use were hypothesized to increase susceptibility to peer influence. The results indicated that adolescents who did not value school achievement or spending time with parents were more apt than others to choose friends who smoked cigarettes more than they did. Adolescents who chose friends who drank more than they did not differ from other adolescents on any of the risk factors. Thus, low-risk adolescents were as likely to acquire a friend context where drinking was likely to occur as were adolescents who had more risk factors. When the second stage was examined, only high peer acceptance and high friendship quality resulted in adolescents being more apt to conform to their friend's substance-use behaviors.

Adolescent↗

Pieter van Keep Memorial Lecture. Menopause--a modern perspective from a controversial history.

The major milestones in the history of menopause provide a fascinating background to understanding current attitudes and prognosticating future trends in the perception and management of this event through which all women will inevitably pass. 'Menopause' is a word of multiple meanings. Once the subject of taboo; now almost in danger of overexposure. Once neglected, now recognized by multiple groups as the entry to a 'market'. The result is a new level of confusion and even exploitation in the minds of the health profession and the public alike. A historical survey of issues relating to the menopause is therefore an ideal vehicle for providing information and perspective into this fascinating and extremely important component of women's health care. One milestone on my personal historical journey is labeled 'Pieter van Keep', a time and a place where we met, forged an instant and remarkable friendship and during the course of an extraordinary day conceptualized a menopause club, ultimately the International Menopause Society (I.M.S.), a journal to become Maturitas, and an idea for enhanced quality years for women by primary preventative health care, utilizing menopause as a positive entry point. Achievement of the dream of wide scale introduction of preventive health care services to a properly informed public is certain to be as successful in reducing morbidity to older women as was the introduction years ago of proper prenatal care in reducing death and disability related to childbirth. Where we were, where we are generally and the I.M.S. specifically, and where the I.M.S. should position itself in the future is the focus of this lecture, my personal 'swan song' to the I.M.S.

Attitude of Health Personnel↗

The Zoology Department at Washington University (1944-1954): from undergraduate to graduate studies with Viktor Hamburger.

Beginning from an undergraduate's perspective and continuing through graduate school, this student's experiences in the Department of Zoology at Washington University in St. Louis, Missouri was a time of many rewarding experiences. Now, on this occasion of his 100th birthday, I wish to express my appreciation to the Chairman, Dr. Viktor Hamburger, for his teachings, his encouragement, and his friendship that has lasted over the past 56 years.

Animals↗

Counseling about sexuality in the older person.

The clinician's challenge is to help older individuals develop and sustain the intimate relationship that they desire. This involves active assessment and teaching on how to improve and continue their sexual health by actively reviewing health concerns and conditions that affect sexual functioning and libido. Older adults should be given information, education, and concrete direction to assist them in creating and sustaining intimate relationships. Older adults are increasingly vigorous with fairly good health and desire information and support to help them maintain their activity and sexuality. Health care providers should assist older adults in being sexually creative and understanding that there is more to a satisfying relationship than the purely genital approach. The refining of a more loving relationship includes encouragement of intimacy, sensualness, companionship, and friendship, as well as continued knowledge and understanding about the effects that one's health conditions, medications, and treatment have on sexuality and functioning.

Aged↗

No baseline for blood pressure in ordinary life: another case of transient chronome alterations.

Half-hourly systolic (S) and diastolic (D) blood pressure (BP) and heart rate (HR) monitoring with gaps demonstrates transient elevations of unknown origin of the chronome (time structure)-adjusted mean, the MESOR, M, of BP, and of the circadian double amplitude of BP of TS, a clinically healthy-appearing engineering student who was 27 years of age at the start of the study. An assessment of large and small arterial vessel elasticity was in keeping with no detection of functional or structural alteration in her vasculature. The recovery of normality in BP endpoints at the time of this report is speculatively associated with a weight loss of 40 pounds and the formation of a friendship by correspondence. Whatever the underlying mechanisms of a long series of abnormal records may be, a 'baseline' can include weeklong spans of abnormality and is best replaced by comparisons with chronomic reference values.

Activities of Daily Living↗

Resource utilization by children with developmental disabilities in Kenya: discrepancy analysis of parents' expectation-to-importance appraisals.

The purpose of this study was to describe parental perceptions of eight physical and human resources available to meet the needs of children with developmental disabilities in Kenya. Specifically, the study assessed the discrepancy between the importance parents attached to specified resources and the expected use of those resources by their children with developmental disabilities. Discrepancy analysis was conducted on parents' expectation-to-importance appraisals of eight resources identified in previous research including, health, education, friendships, husband/wife, religious organization, community membership/acceptance, employment/work, and home. Overall, parental appraisal of likely access-to-importance was significantly related across all eight physical and human resource areas. Discrepancy scores ranged from negative, through zero, to positive, categorized underutilized, congruent, and over-utilized, respectively. Chi-square analyses were non-significant for gender across all resources with only slight gender differences noted on three resources. Most parents reported a match between expected use and importance in five of the eight community resources, health (57.4%), friends (54.6%), religious affiliation (59.8%), acceptance in the community (60.3%), and having one's own home (62.6%). However, "husband/wife" fell outside the congruent range (50.4%), with slight gender differences noted. Finally, two resource areas where the majority of parents reported noncongruence were educational programs and employment/career service.

Child↗

Four-year follow-up of children with low intelligence and ADHD.

Twenty-six of 30 participants (87%) who took part in a medication study for treatment of ADHD were followed up 2.9 to 4.8 years (Mean = 3.9 years) later. Parent ratings on the Aberrant Behavior Checklist Community (ABC-C) indicated continued problems on the acting-out subscales, and parent assessments on the Stony Brook Checklist-3R showed a high rate of difficulty on domains called ADHD. Conduct Disorder, and Separation Anxiety Disorder. A high percentage of children (69%) were taking psychotropic drugs, substantial numbers of their families had sought nonmedical treatments, children's friendships were often rudimentary, and a significant minority of children had disciplinary problems in school or difficulty with the law. Using Pearson correlations, we identified a number of initial variables that predicted follow-up parent ratings on the ABC-C and Stony Brook. The ABC-C Irritability subscale was useful in predicting both internalizing and externalizing problems at follow-up, whereas parent and teacher hyperactivity subscales failed to predict later hyperactivity. Children identified with both low intelligence and ADHD appear to have significant behavioral and emotional problems in their early adolescence, and there may be some important qualitative differences in the outcome of these youngsters as compared with that of children identified with ADHD and normal IQ.

Adolescent↗

Construction and psychometric properties of sexuality scales: sex knowledge, experience, and needs scales for people with intellectual disabilities (SexKen-ID), people with physical disabilities (SexKen-PD), and the general population (SexKen-GP).

This study reports on the development and assessment of the psychometric properties of three measures to assess sexual knowledge, experience, feelings, and needs. The first was designed to assess the Sexual Knowledge, Experience, Feelings, and Needs of people with mild intellectual disabilities (SexKen-ID). The two parallel measures were designed to assess the same areas of sexuality among people with physical disabilities (SexKen-PD) and among the general population (SexKen-GP). The areas of sexuality included in the scales were Friendship, Dating and Intimacy, Marriage, Body Part Identification, Sex and Sex Education, Menstruation, Sexual Interaction, Contraception, Pregnancy, Abortion and Child-birth, Sexually Transmitted Diseases, Masturbation, and Homosexuality. Generation of the items in these scales is described in Studies 1-3. Study 4 describes the evaluation of the psychometric properties of the scales. Sixty-six people with intellectual disabilities, 54 people with physical disabilities, and 100 people from the general population completed the scales. Test-retest reliabilities were also calculated with 30 people with intellectual disabilities, 30 people with physical disabilities, and 30 people from the general population. These data demonstrate the good psychometric properties of the scales and so their simitability for assessing the sexual knowledge, experience, feelings, and needs of people with disability.

Adult↗

Self-reported voice problems among three groups of professional singers.

A vocal health questionnaire was administered to three groups of professional singers and a "friendship-matched" group of nonsingers in Melbourne, Australia. The responses of 79 opera, 57 musical theatre and 31 contemporary (excluding rock) singers and 86 nonsingers were analysed. The questionnaire solicited information regarding biographical data speaking and singing voice-use behaviours, and vocal health over the previous 12 months in terms of experiences of vocal impairment, vocal disability, and handicap. Significant differences between singers and nonsingers in the prevalence and nature of voice problems were reported. Of the singers, 44% reported one or more occurrences of a diagnosed vocal condition compared to 21% of nonsingers and 69% of singers experienced vocal disability compared to only 41% of nonsingers, over the previous 12 months. In contrast, no significant differences were found between the three different styles of singers in their experience of vocal impairment, disability or handicap.

Adolescent↗

Concepts and items in measuring social harm from drinking.

Social epidemiological traditions of asking about problems related to drinking are considered. The issue of the attribution of the problem to drinking, and variations in formulations concerning this, are discussed. Social problems from drinking are inherently properties of social interactions, so that they are composed both of behaviour deemed problematic and of a reaction by another. Most items measuring social harm asked of the drinker him/herself are concerned with major social roles, and problems in the particular life area of the role (work, family, friendships, etc.). Some ask the respondent to attribute the problems to alcohol, some ask about others' attributions to alcohol, and some ask about "objective" problem indicators, although these usually have the respondent's attribution to drinking built in. The possibility of a more systematic way of covering different aspects of interactional problems, as reported by the drinker, is considered. Traditions of questioning the person on the other side of the interaction--i.e., items about others' troubles with drinking, and the effect of these on the respondent--are also discussed, and possibilities for bringing questions asked of the drinker and questions asked of interacting others into the same frame are considered.

Adolescent↗