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Minority politics in the house of medicine: the physicians forum and the New York County Medical Society, 1938-1965.

The late 1930s challenged laissez-faire medicine. Recognition of serious inadequacies in the distribution of medical services stirred activists who questioned fee-for-service delivery and posited a national health program, including health insurance. The AMA and its components--state and county medical societies--counterattacked, mobilizing money and their powerful political arsenal to fight government intrusion in private medicine. The Physicians Forum, initially under the leadership of Ernst P. Boas, emerged as a formidable element within the New York County Medical Society (the largest component of the AMA). The Forum provoked discussion of medical indigence and economics, upsetting the Society leadership with independent candidate slates and telling the public that doctors spoke with more than one voice. For 25 years, the Physicians Forum altered the dynamics of the Medical Society of the County of New York. While the Forum effort to institutionalize minority opinion in the councils of medicine failed, the interchange between County regulars and Forum insurgents broadened the medical reform agenda and moved the County Society in directions that historically it had avoided. Although medical economics formed an unbridgeable chasm between County regulars and rebels, Forum members demonstrated that medicine was not monolithic, that "majority opinion [was not] ... unanimous opinion," and that doctors must speak to issues of medical and social policy.

American Medical Association↗

[Early discharge project appropriate for the healthy newborn].

Recently the stay in the hospital of the pueperae and of their newborns has progressively been shortened in several Countries. A lot of reports evaluating the risks of early discharges have not shown any significant differences in the hospital readmission rates between newborn early discharged and case-controls. This phenomenon is occurring also in Italy and the early discharge after the delivery is one of the aims of the "Percorso-Nascita" in the National Health Program of 1998-2000. Since three years ago, in the Nursery of the Department of Neonatal Medicine of University of Parma we have been discharging the newborns at term in the second day of life, choosing the healthy newborns in agreement with the obstetricians. The increment of the early discharges has happened in our Department after realizing that those did not create an increment of the hospital admissions in the neonatal period. Since January 2000 in Parma the project of appropriate discharge named "around the cradle" derived from the cooperation between hospitals and territory is working. This project consists of a continuous essistential support for mothers and children throughout an organic integration between hospital and territory. The women that take part to this project have the opportunity to be discharged from the hospital between the 44 and the 56 hours after the physiological delivery, being followed at home by the local obstetrician and paediatrician. The project is divided into three parts. The first part, pre-partum, is based on the information that is delivered to all the pregnant women that are eligible; the second part, the hospital phase, implies the usual and routinary care to the pueperae and their newborns as well as the clinical neonatal and obstetrical evaluation that allows to select our cohort. In the latter phase, extra-hospital, the local paediatrician take care of the newborn and start examining him/her within 72 hours after the discharge, while the home assistance of the local obstetrician will be within 48 hours. After initial difficulties, the organization of this project is quite efficient with a constant increment of attending requests to our project by the patients. Of course this is an organizative model quite complex that needs to verify process, efficiency and results, but anyway it sees the cooperation among many professionists of different specialities: neonatologists, paediatricians, obstetricians, practitioners, all working together for a common programme.

Humans↗

[The value of occupational health in the national campaign against tuberculosis in Morocco].

Tuberculosis is a major public health problem in Marocco, with an incidence of 100 cases per 100,000 people. Occupational health could make a substantial contribution to the national anti-tuberculosis campaign, as the principal aims of occupational health are to protect and to improve the physical, mental and social well-being of the workforce. Occupational health thus devotes considerable attention to the promotion of health in general, and the fight against tuberculosis in particular. Occupational health physicians can play a major in several areas: prevention, screening, management of patients, compensation and epidemiology. The generalization of medical cover in the work environment in Morocco requires the application of laws already in place, the creation of occupational health departments, the training of occupational health physicians and the raising of their awareness concerning the anti-tuberculosis, and the involvement of doctors in municipal hygiene offices in the framework of a national health program for the entire workforce.

Health Priorities↗

IMA to conduct training courses in family planning.

For the last six and a half decades, the Indian Medical Association (IMA) has been actively engaged in Public Health issues, ranging from immunization, ORT, maternal and child health care, and has been cooperating with the Government of India in various National Health Programs. Recently, IMA organized a new and exciting program on India's most significantly health issue--family planning. The training is to be competency based and participatory, with the main emphasis on knowledge, attitude and skills required to provide comprehensive child spacing. IMA has developed this multilevel program to train personnel in all methods of family planning, like: participation in basic oral contraceptive training; supplementary training in other methods; clinical practice for providing information on how to select and manage non-clinical family planning services; simulated practice in IUCD; and clinical practice in IUCD training. Training can also be arranged for vasectomy practicum and minilaparotomy. The main purpose of the training program is to realize the Government's goal of 60% contraceptive prevalence usage by the year 2000. In India, less than 2% of the 132.5 million reproductives, couples use oral contraceptives, because of widespread misconceptions regarding the pill among the general populace and the medical community. This program has been designed to counter these misgivings and thus encourage the "use of modern family planning methods" to take on the menace of the population explosion.

Asia↗

[Considerations on the admission policy for the medical school of the university of Costa Rica].

A study conducted by the University of Costa Rica examined the ratio between the total national population and the number of physicians, as well as the variations that might occur in this ratio depending on population growth, annual number of graduates from the School, incorporation of foreign medical graduates, and deaths in the physician population. The purpose of the investigation was to give the school sufficient information to formulate admissions policy that would take into account the needs of national health programs and the demand for medical care services.

Costa Rica↗

[Application of a model for predicting morbidity in children from a low socioeconomic level].

An instrument to be used at a primary health care level was built on the basis of a predictive model for diarrhea obtained during a previous study. The instrument was applied to 720 mothers or caregivers of infants living in the Southeastern area of Santiago. 83 infants who fulfilled the requisites of the instrument were surveyed during July-August 1989 and compared to age, nutritional and socioeconomic status matched children not fulfilling the same requisites. Infants selected by the predictive instrument suffered 4 times more morbid episodes and respiratory infections and 5 times more diarrheal episodes than controls. Symptoms were present in them during 50% of the survey period as opposed to 14% in controls. Mothers of children at risk had inadequate behaviors in respect to health care of their children and did not follow many of the National Health programs available for their families. The predictive instrument tested may be useful to identify children at high risk of morbidity, creating the possibility for special interventions in them.

Child Welfare↗

[Drinking practice and alcohol-related problems: the national representative sample survey for Healthy Japan 21].

This article is the first survey report in Japan concerning the adult drinking behaviors and its overall alcohol-related problems based on a national representative sample. It deals with a wide range of alcohol topics such as frequency, volume, cultural aspects, social influence and its effect on individuals, both positive and negative as well as various other alcohol related problems. The report identified, for further implementation of Japan's national health program, "Healthy Japan 21", the following areas of focus; 1) 5% of males and 0.5% of females who are considered "Hard Drinker", the most prioritized target. Seemingly small portion of females, 0.5%, is far beyond the planned goal level. 2) The cultural and regional competency is highly expected for policy discussion and evaluation in order to decrease the hard drinker population by 20% off. 3) Clarify the definition of a "Hard drinker" and disseminate the information publicly for functional health monitoring activity by local governments.

Adult↗

Visual disabilities among diabetics in Oman.

OBJECTIVE: The magnitude, determinants of visual impairment, bilateral blindness and low vision among diabetics in Oman were estimated as part of Oman Diabetic Eye Study 2002. This study presents the outcomes and additional risk of visual impairment in diabetics. METHODS: A cross-sectional study of 2,520 randomly selected diabetics was conducted in 2002 in 10 regions of Oman. The sample was represented by 5,564 diabetics referred for eye checks. Ophthalmologists noted the vision and ocular manifestations of diabetes. Physicians reported the systemic manifestations of diabetes. The magnitude of visual disabilities, bilateral blindness, legal blindness and low vision were estimated and compared to the rates in the population. RESULTS: The prevalence of visual impairment in diabetics was 28.4% (95% confidence interval [CI] 27.20-29.57). It was 34.6% (95% CI 32.93 to 36.32) in females and 21.2% (95% CI 19.59 to 36.32) in males. The prevalence increased in age. The prevalence of bilateral blindness (vision <0.05) was 0.7%, legal blindness 9.8% (vision <0.1) and low vision 27.7% (vision <0.5). CONCLUSION: The risk of visual impairment is 25 times more in diabetics than in the Omani population. Therefore, to prevent further increase of visual disabilities, the national health program should prioritize the eye care in diabetics and the predictors of visual disabilities should be further investigated.

Cross-Sectional Studies↗

[The attitude of sixth year students of the Faculty of Medicine towards the problem of addiction to nicotine].

According to the guidelines of the National Health Program, assumed by the Polish Ministry of Health for the years 1996 - 2005, it could be expected that, particularly at medical universities, education of future doctors in the field of problems connected to addiction to nicotine is taken into consideration. However, the research conducted in the form of anonymous survey among the sixth year students of the Faculty of Medicine at the Medical University of Białystok in the academic years 2001/2002 and 2004/2005 does not corroborate those expectations. The survey proves that the future graduates' knowledge of the aforementioned topic is fragmentary and confirms the necessity of including that issue in the educational curriculum in the area of family medicine.

Adult↗

Osteoporosis prevention: a reasoned examination of food habits and physical activities in a schoolchildren population in central Italy.

OBJECTIVE: The dietary intake of calcium is fundamental for prevention of osteoporosis, especially in the first three decade of age to gain a valid peak bone mass; moreover physical activity is important for the same reason. The objective of our research is to examine the food habits and the way to practice sport in a homogenous population of schoolchildren. MATERIALS AND METHODS: Data were collected by an original questionnaire in 500 schoolchildren (238 males, 262 females, 9-12 yrs) living in the centre of Italy. RESULTS: Data show that the calcium intake decreases while the age increases. According to the recommended daily calcium dose, the percentages of insufficient calcium intake were 21% in the 6 years old group, 35% in the 7 to 10 years old group and 52.5% in the 11 to 14 years old group. Milk and dairy products cover 57% of the calcium needs (17% and 40% respectively), water covers 24% and the other foodstuffs 19%; moreover most children (43.5%) practice non competitive sports with a preference (58.3%) for no-weightbearing sports (mainly cycling) over weightbearing sports (mainly football). CONCLUSIONS. This survey suggests that a high percentage of young people do not take the recommended daily dose of calcium (especially interesting that becoming older with consequent lower parental control over the diet, the higher the incidence of poor calcium intake increases), then it would be recommendable to establish a national health program promoting appropriate physical exercise plus a correct calcium intake as early as the primary school.

Adolescent↗

Curing America's health care system.

America's health care system is characterized by unacceptably high cost, inequity, and insufficient technology assessment. Cost containment has failed in part because of misunderstanding of the nature of the health care system. Inadequate technology assessment and the malpractice crisis have also contributed to the rise in health care costs. Explicit, systematic rationing of health care services is one way to radically alter the existing system; the instituting of some type of national health program is another. Less drastic measures include systematic technology assessment; growing emphasis on group medical practice; more preventive services; and malpractice reform, including exploration of no-fault legislation and an expanded federal role.

Delivery of Health Care↗