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Recent legislative enactments whose goal is control of hospital decision making are diminishing the governing board's traditional responsibility for the hospital's future. Trustees can resist this erosion of their authority by working with government to ensure that the health planning system is as effective as possible. This new political function could well become the trustee's most important role.
A variety of health measures during this century has resulted in marked increases in the number of people reaching old age, particularly 85 years of age or more. Two recent measures include lifestyle modification to lessen rates of coronary heart disease (CHD) and control of hypertension to decrease stroke events as well as to lessen CHD risk. This review presents approaches for considering the social, ethical, economic, and political implications of prevention of CHD in the elderly. It reviews demographic and other characteristics of our aging society and discusses what thier implications are as research in the biology of aging results in the prolongation of life.
In both myth and Genesis (by God) the creation of the world begins with the separation of water, sky/air and ground; later appear the life and the man and from Olympic divinities (or God) derive health and disease and remedies. When Milesian philosophers distinguished between nature (to be observed) and speculation, a parallel revision has been made in the medicine, from theurgical to rational one. Thus, Hippocratic medicine pointed attention on air waters and places as natural environmental elements, to be observed, as method to understand the probable diseases of a city, also with a role of political institutions, says the Hippocratic treatise De aëre. Centuries later, only in the 19th century has been rediscovered the importance of environment in the health's policy, a concept full developed in the last time (i.e. health and pollution, health and quality of life).
The author has sumarized the role of well known 19th century doctors, Thackray, Villermé, Chadwick and especially Virchow (whose socio-medical works are related in detail), in the influence of political ideas on Medicine. As a new contribution to this subject the author informs us of the participation or a Spanish homeopathic doctor in this task. Anastasio García López (1821-1897), was influenced by the works of Charles Fourier, whose doctrine was spreading throughout Spain at that time. García López aplied the sociological concepts of the French utopian philosopher to his idea of homeopaty. A review is made of how Fourierism penetrated and became implanted in Spain and the mark it left on Hahnemann is analized using the "passionate attraction" concept and the ideas of social constriction and violence. García López believed that Hahnemann was attempting to free therapeutics from the yoke of attacking symptoms, emphasizing the affinities of the illness with the cure. Finally, this influence is demostrated in all the activitires of this Spanish doctor, politican, spiritualist, mason and hydrologist of renown.
In response to the many legislative changes occurring in health care during the past few years, your Professional Practice Committee has developed the following Fact Sheet to help WOCN members become more politically active. For many of us, the process of contacting our legislators on issues that affect our patients, our payors, and our individual practices can be confusing, overwhelming, and time consuming. As health care legislation continues to evolve and change, it is imperative that we voice our professional and our personal opinions to those who will listen. This Fact Sheet was drafted after reviewing the legislative documents of other professional nursing organizations. This format allows members to quickly access the communication venue they would like to use to contact their representatives and provides tips for effective interactions. Remember, while it may take time, change is possible. Empower yourselves and add your voice to the legislative process so you have an impact on future health care policy.
The purpose of this paper is to examine and analyze policies towards adolescent sexuality within a total institution. The issues are discussed from the perspective of 4 different domains: clinical, experiential, ethical, and theoretical. Considerations from all 4 domains interact. When the interactions are not made explicit, it is possible that 1 domain may override the others. This, in turn, may produce undesirable side effects such as defensive justifications of policies or distortions of the less favored domains. Included among the issues examined are: policies regarding sexual relationships between patients who are simultaneously engaged in psychotherapeutic relationships; institutional rulings on sexual behaviors; coeducational units for adolescents; and decision making about birth control and abortion for adolescent psychiatric patients. Clinical illustrations from a residential treatment unit for severely disturbed adolescents are provided. Within the context of adolescent sexuality, the 2 diametrically opposed models of psychiatric institutions are contrasted. The 1st is based on ethical concepts of autonomy and antitotalitarianism, while the 2nd model uses a clinical paradigm which recognizes psychodynamic intricacies as well as the restricted autonomy of severely disturbed adolescent patients. When this latter approach is taken to the extreme, it prescribes profound limitations on patients' behaviors, particularly those behaviors with sexual etiologies. In actuality, these 2 models form the poles of a myth. The clinical pole functions entirely within a model that does not allow for individual and ethical considerations while the ethical pole denies psychodynamic complexities. It is obvious that quite different administration decisions will stem from the respective models. A comprehensive framework for discussion of the politics of sexuality in adolescent psychiatry utilizing all 4 domains is proposed. To that effect, the current ethical and clinical myths should be critically analyzed, discussed, and then transcended.
The first research institution exclusively devoted to psychiatric genetics was the Department of Genealogy and Demography at the German Psychiatric Research Institute (Deutsche Forschungsanstalt für Psychiatrie) in Munich. From its foundation in 1917 until 1945 it was directed by Ernst Rüdin, one of the protagonists of the racial hygiene movement in Germany. In scientific terms, colleagues from abroad regarded the research undertaken by Rüdin and his collaborators as outstanding in 1933/34, and as remarkable even in the post-1945 period. This paper analyses programme and practice of psychiatric genetics at the Munich Institute as well as Rüdin's involvement in Nazi mental health policy including his active support of the systematic patient killings ('euthanasia'). It is argued that the idea of a healthy 'race' was a guiding principle motivating all of Rüdin's research and political activities, and that it is not possible to distinguish in his work a phase of 'good' research (in scientific terms) untainted by racial ideas from a phase of 'bad' (pseudo-) research contaminated by racial ideology.
In the research of Cécile and Oskar Vogt during the 1920s at the Kaiser Wilhelm Institute for Brain Research, the notion of race had a double function. Firstly, it integrated the mapping of brain functions, the classification of psychiatric diseases, genetics, and evolutionary biology. Secondly, it proved useful in attracting funding for the creation of research facilities in Germany and the USSR. After 1933, C. and O. Vogt stopped using the term race for political reasons, but tried to offer their work as a contribution to eugenics. Bernhard Patzig, their collaborator, continued their approach during National Socialism. Distancing his research from Rüdin's statistics on heredity, but working within the paradigm of eugenics, he established the hereditary nature of certain neurological diseases and psychotic disorders such as schizophrenia.
Decisions about delivery programs to improve health status are characterized by indivisibilities or "lumpiness," interdependencies between case types with varying health output, high fixed costs, administrative constraints, and qualitative quity and political considerations. The nature of the constraints and the goal of health services strongly suggest a mathematical programming model to maximize a comprehensive measure of health status. In a previously unreported development, binary integer programming can be extended to consider shared fixed costs, a widespread problem in optimizing effectiveness measures such as health status. The model proposed here applies conceptually across all target populations and health programs and could be used to optimize the output of a total health system. The effects of such optimization would be appropriately reflected in the weighted life expectancy computed as a social indicator.
The aim of this study, which was conducted in a refugee camp of the African National Congress in Tanzania, was to analyze the caries experience in relation to perceived stress and sleeping problems and stressful experiences among South African political refugees. A sample of 194 persons, aged 11 to 39 years, was examined clinically and interviewed. There was a consistent association between caries experience and the different parameters for estimating perceived and experienced stress. In particular, the aggregation of different stress indicators seemed be strongly related to higher caries experience.
The meaning of population pressure is discussed and, with the help of a formula, its five main components (people, rate of increase of people, food-producing acreage, protein nutrition and industrialization) are analyzed.Factors which have eased population pressure in the past are considered under the headings of political violence (war and genocide), natural disaster (famine and disease), and social action (increased local protein supply, emigration, industrialization and birth control).Birth control is the first prerequisite to an easing of population pressure; the effectiveness of the Japanese and the Indian programs is discussed.The crippling burden of preventable disease, shown to be a major obstacle to the development of sophisticated industries, presents a challenge to Western medical men who so far have done little to meet it.
In October 1983, Medicare launched a new payment system that would no longer write hospitals a blank check. It was called the prospective payment system and became known simply as the PPS. With its 20-year anniversary looming, the program's fundamental strengths and weaknesses have become apparent. Although some say it's vulnerable to politics, most agree it has imposed order on hospital finances.
An American Hospital Association lobbyist's fund-raiser for the Bush-Cheney re-election campaign last week at Washington's Capitol Hill Club raised eyebrows, along with questions about the gray area between personal advocacy and the industry's political agenda. The AHA was not involved in the event, association officials say, but some observers remain skeptical.
From the deep sense of frustration about the gap between what is possible and what is actually happening, a clear consensus emerged at the XIV International AIDS Conference that effective action is urgently required. This article is based on a presentation on 12 July 2002, the last day of the conference, by Terje Anderson, the rapporteur for Track G. The article presents a summary of the discussions in Track G on topics such as advocacy strategies, the use of the law, the use of a human rights framework and approach, the role of people living with HIV/AIDS, and the need to mobilize sufficient resources. The article states and then critically examines some of the consensus positions that emerged from the conference--specifically, the goal to have three million people on antiretroviral therapy by 2005; the notion that the debate around prevention versus care is over; and the idea that the key issue is no longer what we do, but how to secure the commitment and the resources to do it. The article states that the fight against HIV/AIDS must be fought on a political plane, and that it is the responsibility of everyone working in AIDS to engage our leaders. The article concludes by asking whether we really have the courage and the perseverance to turn our knowledge and our commitment into action.
The case for methylphenidate (MPH) (Ritalin) rests on claims that Attention Deficit Hyperactivity Disorder (ADHD) is a disorder, that ADHD is biologically rooted, that MPH is effective against ADHD, that nontreatment is developmentally hazardous, and that MPH is a relatively innocuous rather than dangerous treatment. It will be found that the case for MPH rests on the hope that ADHD is a biological disorder and on MPH's short-term suppression of disruptive behavior. The explosion of MPH use on this flimsy evidential base can be explained within a political economy analysis but is difficult to justify ethically. It suggests a disturbing reliance upon drugs to solve problems stemming from a combination of inadequate support for families in modern societies and educational systems pushed to do more with less. Reliance upon a psychoactive medication to make children "ready to learn" is not only unsupported by the evidence, it teaches children incorrect lessons about how to meet the stresses and challenges of life.
The obesity epidemic is producing growing interest in public policy measures targeting prevention. We developed a printed survey suitable for mailing to primary care physicians in Louisiana. Questions were asked concerning health policies relating to motorcycle helmet use, smoking, and obesity. We also obtained personal data, including type of practice, gender, age, ethnicity, personal income, height, and weight. Of 993 surveys mailed, there were 218 responses: 74% were male, 55% were from East Baton Rouge parish, an urban location, and 84% had an income of > dollar 100,000. Of respondents, 74% strongly agreed with helmet laws, 73% strongly agreed with limitations on smoking spaces and 62% strongly agreed with cigarette taxation. Concerning health policies related to obesity prevention, strongest support was for school concession policies, with 73% reporting strong agreement or agreement. There was support for regulating food advertisements, where 60% agree or strongly agree. However, only 29% agree or strongly agree with the taxing of unhealthy foods, compared to 78% of respondents favoring cigarette taxation, a statistically significant difference (< 0.0001). Support was particularly weak for governmental involvement in obesity discrimination, with only 16% of respondents agreeing or strongly agreeing. Political response to the obesity epidemic is only now emerging. However, our survey indicates that support among Louisiana physicians for obesity-related policy is not equal to support for policies directed against helmet and smoking laws.
An eco-historical analysis facilitated the identification of the socio-political, demographical and environmental changes that have affected the distribution and abundance of vertebrates living in Israeli and Palestinian territories, their pathogens and the extent of human - animal contacts, all contributing to the risk of rabies, leading to three deaths in the late 90's. There are indications that the implementation of uncoordinated control strategies with a lack of an ecological perspective on one side of the border, such as the destruction of the main reservoirs, led to the emergence of a more potent reservoir coming from the other side, and the creation of an additional on yet to be identified. We analyze the lessons of historical mistakes, aiming at future regional control of the disease.
History of medicine played an important part in the ideology and policy of the Third Reich. The Nazi Party and the "Schutzstaffel" (SS) tried to instrumentalize historical knowledge to justify their ideology and medical ethics. The academic discipline of the history of medicine saw a revival during the Nazi period and, especially, during the Second World War. Important medical historians were eager to contribute to a symbiosis between the State and their field. The close relationship between the history of medicine and the Nazi regime was particularly apparent at Paul Diepgen's Department for the History of Medicine and Natural Sciences at the University of Berlin. Diepgen, apart from his own collaboration with the Nazi regime, was the teacher of Bernward J. Gottlieb who became the leading medical historian of the SS and Director of the new "SS-Institute for the History of Medicine" in Berlin in 1941. Gottlieb's institute moved in 1943 to the "SS-Academy" in Graz to train future SS-physicians in the history of medicine. The history of medicine was of great relevance also for certain members of the Nazi elite. They included Heinrich Himmler, the head of the SS, who ensured that Gottlieb would become Diepgen's successor in 1945 for the chair of medical history at the University of Berlin. Hitler was asked to intervene in the appointment process given the political importance of the field and, in particular, the professorship being located in Berlin. The SS was able to exercise, by this time, a decisive influence on the field of the history of medicine. Only the collapse of the Third Reich prevented the traditional discipline from becoming a "science" to legitimize the Nazi System and the SS. The aim of this paper is to examine the role of the field of the history of medicine and of its key institutions and personalities during the Third Reich.