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[Adalbert Friedrich Markus (1753-1816): remarkable organizer of health service, philosopher, sponsor, and social figure].

Adalbert Friedrich Markus (1753-1816) was one of the most eminent doctors of his time. His name was given not accidentally to one of the largest squares, a street and a bridge across the river Regnitz in Bamberg, the town where he worked more than 40 years. Markus was well-known among the population as an excellent doctor, he also was a personal doctor of Kurfürst bishop Franz Ludwig von Erthal. Markus was the first principal to found a hospital affordable to everyone, where medical personnel was taught and many professors worked. He was also founder and principal of the medico-surgical school, whose program of studies was equal to those of an university. On Markus' initiative a birthhouse was founded, as well as a sheltered housing complex for the elderly and a school, as well as a social system for poor citizens. In January 1803 Markus became the head of the health department of the principality of Frankonia. On his initiative a free smallpocks vaccination for all new born was carried out. Markus brought up an annual report of medical science and numerous magazines on therapy. In his scientifical articles in different magazines he wrote about diseases of respiratory tract, skin, liver, as well as typhus and feaver. In many of his published works he appears to be a philosopher supporting a naturalistic philosophy and disagreeing with its idealistic attitude at the same time. He was the head of a literature society called "Harmony", and he supported the construction of the first theatre where E. T. A Hoffmann worked who was a friend of Markus. A. F. Markus' death 1816 put his friends and supporters into a deep grief. According to the newspapers of that time, the whole town followed the funeral procession and all the churches rang their bells goodbye. The name of A. F. Markus has an important place among the extraordinary German physicians of the late 18th and early 19th century.

Germany↗

[Socio-hygienic rationale for the preparation for retirement (author's transl)].

The objective of the study made within the framework of bilateral cooperation between the Institute of Gerontology of the Academy of Medical Sciences, Kiev and the GDR Research Project of Social Gerontology was to provide a scientific basis for the health-promoting and rational way of life of elderly persons of pre-retirement and retirement age. 1,500 Kiev citizens of pre-retirement or retirement age were examined and/or interviewed. Like similar investigations conducted in the GDR, the Soviet findings showed a highly significant correlation to exist between health education, healthy living. Knowledge about one's health and health-promoting behavior. The poorest results were obtained for unskilled or semi-skilled production workers, both male and female. They had the highest proportion in advanced degenerative diseases. The persons investigated were best informed about the positive influence of exercise, a balanced diet, periodic medical check-ups and home visits by doctors. The effectiveness of health education and health propaganda was calculated by means of efficiency indices. Generally speaking, the relation between knowledge and action is still inadequate. This applies primarily to preventive measure by the individual and to the organization of his daily regime (indices just over 50%). The indices related to diet and exercise were higher (71 and 72%, respectively). Adverse psychological factors included a lack of concrete plans for retirement age, a rather passive mode of life and dissatisfaction with the situation during pre-retirement and retirement age. An active approach to old age proved much more favourable, including satisfaction with one's life and with the present situation. A significant correlation was found to exist between a non-rational way of life, morbidity and multi-morbidity. The results of the study will be used to make recommendations regarding to the preparation for old age, especially for the transitional period between pre-retirement and retirement age.

Activities of Daily Living↗

The excesses of individualism. For meaningful healthcare reform, the United States needs a renewed sense of community.

In the United States at the end of the twentieth century, the balance of values tilts too far toward the individual and away from the community. What is needed is a renewed sense of community that enhances the lives of individuals as it serves the common good. The first step toward creating a new balance is a critique of the present imbalance, which is shaped by excessive forms of individualism that affect every aspect of our healthcare delivery system. Technological individualism occurs when the value of technology is measured only by its service to the individual. The results are a technological imperative, unreasonable expectations on the part of the community, distorted judgement on the statistical likelihoods of individual outcomes, fragmentation of care, and a reliance on rescue medicine. A psychosocial individualism has misshapen our attitudes about ourselves and our communities, bringing with it a deepening sense of alienation. The results in U.S. healthcare include commercialization, exclusion of the poor, a litigious provider-patient relationship, declining respect for life, and a sense of community that excludes other generations and nations. Libertarian individualism has created political isolation and prevents the evolution of democratic decision making and real partnerships in healthcare. The results are an unpooling of insurance risk, an interpretation of freedom that is inimical to family and community ties, hostility to government, a view of healthcare as a commodity, and deprofessionalization of the medical professions. Healthcare reform must seek to change what medical technology does for us, repair the psychosocial harms healthcare individualism has produced, and promote citizen participation in the healthcare system in new and important ways.

Abortion, Legal↗

Predicting emergency evacuation and sheltering behavior: a structured analytical approach.

We offer a general approach to predicting public compliance with emergency recommendations. It begins with a formal risk assessment of an anticipated emergency, whose parameters include factors potentially affecting and affected by behavior, as identified by social science research. Standard procedures are used to elicit scientific experts' judgments regarding these behaviors and dependencies, in the context of an emergency scenario. Their judgments are used to refine the model and scenario, enabling local emergency coordinators to predict the behavior of citizens in their area. The approach is illustrated with a case study involving a radiological dispersion device (RDD) exploded in downtown Pittsburgh, PA. Both groups of experts (national and local) predicted approximately 80-90% compliance with an order to evacuate workplaces and 60-70% compliance with an order to shelter in place at home. They predicted 10% lower compliance for people asked to shelter at the office or to evacuate their homes. They predicted 10% lower compliance should the media be skeptical, rather than supportive. They also identified preparatory policies that could improve public compliance by 20-30%. We consider the implications of these results for improving emergency risk assessment models and for anticipating and improving preparedness for disasters, using Hurricane Katrina as a further case in point.

Behavior↗

Brazilian LTER: ecosystem and biodiversity information in support of decision-making.

Brazil officially joined the International Long Term Ecological Research (ILTER) network in January 2000, when nine research sites were created and funded by the Brazilian Council for Science and Technology (CNPq). Two-years later some positive signs already emerge of the scientific, social and political achievements of the Brazilian LTER program. We discuss examples of how ecosystem and biodiversity information gathered within a long-term research approach are currently subsidizing decision-making as regards biodiversity conservation and watershed management at local and regional scales. Success in this respect has often been related to satisfactory communication between scientists, private companies, government and local citizens. Environmental education programs in the LTER sites are playing an important role in social and political integration. Most examples of integration of ecological research to decision-making in Brazil derive from case studies at local or regional scale. Despite the predominance of a bottom-up integrative pathway (from case studies to models; from local to national scale), some top-down initiatives are also in order, such as the construction of a model to estimate the inpact of different macroeconomic policies and growth trajectories on land use. We believe science and society in Brazil will benefit of the coexistence of bottom-up and top-down integrative approaches.

Biodiversity↗

Ethical problems in psychopharmacological research.

1. Scientific research poses considerable ethical problems which in human psychopharmacological studies are frequently faced by singling out consent as the only reliable source of human respect, although it is never free, spontaneous, or informed. 2. On the other hand, various ethical problems present in the "life" of a new substance in the case of industry and preclinical, clinical and mass experiments, are left behind. 3. Thus there arise justified protests which go so far as disowning science and technology. To criticize science and technology is of no use: incorrect use of them must be prevented. 4. Such a guarantee can only come from an international control committee, capable of coping with a multinational power such as industry, supported by peripheral elective committees, which grant the citizens a direct participation in the administration of health.

Ethics, Medical↗

[From the shelf to the monitor: opportunities and difficulties for psychiatric journals switching from paper to on-line].

The author examines the changes brought about by Internet in the complex field of international medical and scientific journals (and psychiatric journals in particular), since online versions of the printed publications have been made available on the Internet. Attention is focused on the surfeit of these scientific journals and on the economic implications of the transformation. The article underlines how the international scientific community has become conscious of its importance in the production of scientific journals and a description of the very innovative Public Library of Science (PLoS) initiative is also given. The author illustrates the possible future functioning of scientific journals, the so-called "Author pays" model, which is still controversial and closes with comments on the increasingly important role played by direct communication between scientific community and citizens, including the use of specific journals and websites.

Humans↗

Interdisciplinary innovations in biomedical and health informatics graduate education.

OBJECTIVES: Biomedical and health informatics (BHI) is a rapidly growing domain that relies on the active collaboration with diverse disciplines and professions. Educational initiatives in BHI need to prepare students with skills and competencies that will allow them to function within and even facilitate interdisciplinary teams (IDT). This paper describes an interdisciplinary educational approach introduced into a BHI graduate curriculum that aims to prepare informatics researchers to lead IDT research. METHODS: A case study of the "gerontechnology" research track is presented which highlights how the curriculum fosters collaboration with and understanding of the disciplines of Nursing, Engineering, Computer Science, and Health Administration. Gerontechnology is a new interdisciplinary field that focuses on the use of technology to support aging. Its aim is to explore innovative ways to use information technology and develop systems that support independency and increase quality of life for senior citizens. As a result of a large research group that explores "smart home" technologies and the use of information technology, we integrated this new domain into the curriculum providing a platform for computer scientists, engineers, nurses and physicians to explore challenges and opportunities with our informatics students and faculty. RESULTS: The interdisciplinary educational model provides an opportunity for health informatics students to acquire the skills for communication and collaboration with other disciplines. Numerous graduate and postgraduate students have already participated in this initiative. The evaluation model of this approach is presented. CONCLUSION: Interdisciplinary educational models are required for health informatics graduate education. Such models need to be innovative and reflect the needs and trends in the domains of health care and information technology.

Aged↗

From irreversibility to participation: towards a participatory foresight for the governance of collective environmental risks.

This paper presents a reflection on the introduction of methods and tools of "participative foresight" for scientific and technology policy as well as environmental policy fields. Future studies have recently made a comeback under the label of foresight. Future technology studies no longer claim to forecast the future, but are presented as a strategic tool for improving interaction between key actors and for anticipatory policy making. They can be defined as a "process by which one comes to a fuller understanding of the forces shaping the long term future which should be taken into account in policy formulation, planning and decision-making" [Foresight in Federal Government Policymaking, Futures Res. Quart. (1985) 29]. We discuss applications of this approach for perspectives on environmental policy and sustainable development. Foresight opens up the possibility of negotiating a new and more fruitful relationship or 'social contract' between science and technology, on the one hand, and society on the other. The focus has moved from merely scientific and industrial insights to social demand, thus emphasizing the importance of both the production and "supply" of innovation, and the "demand" as signaled in the views of citizens.

Decision Making↗

What should we do about Eduard Pernkopf's atlas?

Eduard Pernkopf created a classic anatomy atlas during World War II. He was also an ardent Nazi. Questions have been raised recently about the propriety of using an atlas created by a Nazi and illustrated by dissections of cadavers whose identities are unknown, but who could have been victims of Nazi political terror. To examine the ethical issues involved, the author first reviews recently published work regarding Pernkopf and his atlas, with the caution that facts are few in a debate where emotions run high and opinions abound. He then considers what has been written by bioethicists on the use of scientific data from the Nazi era and how those arguments might apply to Pernkopf and his atlas. Important questions remain, however. For example, are scientific data tainted by their associations with Nazism, or should such data (including the atlas) be assessed on their own merits, separate from the persons and ideologies involved in their creation? Finally, the author offers his own perspective as a young gross anatomist and physician. He argues that rejecting the hateful beliefs of Pernkopf and his fellow Nazis does not necessitate rejecting the elegant anatomic images they produced. The author further suggests that use of the atlas is itself the most fitting tribute to those who died for it, whether they were victims of Nazi repression or not. Those cadavers not only teach anatomy, they "can remind us of suffering not only in the past but in the present, that we may be more compassionate physicians, more compassionate citizens of the world."

Anatomy, Artistic↗

The U.S. health care system: challenges for the academic health professions community.

The author discusses the need to create structural reforms in the nation's health care system, built around a consensus on workable, affordable solutions, the first of four needs in this area, and presents a set of principles that must frame the debate on health care reform (e.g., that health care must be accessible to all Americans). He also presents practical options that address the United States' most urgent health care concerns (e.g., making the cost of health insurance more affordable for small businesses). The second need is to preserve and strengthen the nation's biomedical research enterprise; the author outlines steps that are already under way to deal with this need (e.g., the development of a Biomedical Research Initiative in the Public Health Service and the allocation of funds for various research-connected activities). The third need is to increase the participation of minority youth in science and the health professions; the author outlines steps that are being taken to encourage such participation (e.g., helping historically black colleges and universities and funding training programs for training minority professionals in health care). The last need discussed is to foster a culture of character: empowering citizens to take control of their own lives to eliminate costly debilitating illness before it strikes. For all these needs to be addressed successfully, it is crucial that the involvement of the academic health professions community and the community at large be expanded.

Delivery of Health Care↗

[Plato: forerunner of demographic thinking?].

Since Malthus, several commentators have noted quantitative considerations in Plato's work, regarding him as a forerunner of demographic thinking. But how to explain several demographic contradictions between the Laws and the Republic? This paper brings out the consistency of Plato's thought, which cannot be demonstrated at a purely demographic level. His fascination for mathematics and the influence of the Pythagorean school should 1st be taken into account. However, the City, as an ideal concept and as a concrete social organization is the key to Plato's thought. Confronted with a basic problem of political philosophy, that of [power and justice, Plato proposed to restore the harmony between the City as a political body and the individual citizens. Hence policy measures which we regard unduly as eugenic and demographic, are in fact based on a conception of man quite different from ours.

Demography↗

[Medical technologist as a member of infection control team].

For the prevention of infection at institutions, an Anti-nosocomial Infection Committee or an Infection Control Team (ICT) is organized at each institution according to its scale. We report the present status of the ICT managed mainly by medical technologists engaged in microbiological examination (certified medical microbiological technologists) at Dokkyo University School of Medicine. Since this hospital is an educational hospital, the department of clinical laboratory medicine cooperates with the microbiological laboratory of the clinical laboratory in infection control education of medical workers (such as medical students, nursing students, physicians and nurses) in infection diagnosis, infection control/infection management. Since infection control is achieved by improvement in hygiene knowledge and its practice in all citizens, we also attached importance to publicity activities associated with microbiology for patients, their families, and all medical workers.

Cross Infection↗

Recent medical-legal proceedings and their effect on the practice of medicine in Chicago.

Since January 1994, northern Illinois has experienced a significant increase in litigation, which has been directly related to the lack of FDA approval of pedicle screw devices, and the adverse media attention to the FDA's actions. These activities coupled with those of the Public Citizen Health Research Group's have had a chilling effect on the practice of medicine. This is unwarranted, Congress has never provided the FDA with the authority to regulate the practice of medicine; and the FDA has reiterated that it lacks the intent or ability for such regulation. Medical science continues to outpace the regulatory process, and therefore it will remain the science of medicine that determines the standard of care.

Chicago↗

[Lowering the promille limit?].

The Legislator's decision not to lower the 0.8 per mile alcohol level limit of the section 240 StVG runs counter to the tendency of fighting dring driving altogether. This decision was made despite the fact, that according to current medical science the risk limit lies at 0.4 per mile. It can't be justified by the "ultima ratio" principle which was introduced by the legislator for decision making. Much on the contrary, it suggests a development where considerations will no longer be applied only for the protection of the citizen. Here we can observe a continuation of the interpretation of the alcohol level limits which seem to simply serve as a means of ensuring a conviction. The economical analysis of the law is the theoretical background to this consideration which dominated by this process. This analysis does not take any further limitations of legislative powers into consideration with the exception of effectiveness, efficiency and its maximum use under the political and economic aspects. Therefore it allows the protection of the individual to be obscured by these maxims. However, lowering of the alcohol level risk limit to 0.4 per mile should not be insisted on, but instead there should be a call for the introduction of an alcohol ban altogether. This request could be justified with the lack of the legal basis of the alcohol level limits.

Accidents, Traffic↗

Education and employment patterns of U.S. Ph.D.'s in the biomedical sciences.

During most of the 1970s and 1980s, the number of biomedical Ph.D.'s conferred in the United States was fairly constant. From 1987 to 1995, however, there was an increase of almost 50% in the number of biomedical Ph.D.'s awarded by U.S. institutions; nearly 70% of this increase can be accounted for by the increase in the number of noncitizens receiving a Ph.D. in the U.S. Although unemployment among U.S. citizens with biomedical Ph.D.'s is now extremely low--less than 2.0%--there have been some important changes in the job market for biomedical Ph.D.'s. The total number of biomedical scientists has grown, whereas the number of faculty positions has remained stable, causing a decline in faculty positions as a percentage of total employment for biomedical scientists. Jobs in industry have increased, and in the future might surpass academic jobs as the most prevalent form of employment for U.S. biomedical scientists.

Academies and Institutes↗

Biotechnology, inquiry, and public education.

Education of our children is arguably society's most important task, profoundly shaping the communities in which we all live. Achievement and success in many facets of our culture depend critically on formal education. Education is widely perceived as the only viable weapon against the poverty, drug abuse, crime and teenage pregnancy that derail many citizens, particularly in the inner cities, from realizing their productive human potential. Beyond its value to individuals, education is the cornerstone of societal advancement.

Biotechnology↗