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PubMed2004

[The Republic of Letters and French physicians on the eve of the French Revolution: the case of Esprit Calvet].

In the broad Republic of Letters of the second half of the eighteenth century, physicians played an important but singular role. The majority of them were forced to earn their daily bread, so only belonged to the Republic in their leisure hours. Inhabiting a double universe--the everyday world of their profession and the more refined world of their intellectual hobbies--they had to negotiate continually between the two. This liminal position of the citizen-physician is recaptured in this article through the example of a physician of the Midi, Esprit Calvet of Avignon (1728--1810). Calvet left a huge correspondence, thanks to which this duality between the practising physician and the citizen of the Republic of Letters can be studied in detail. On the one hand, this is a correspondence between the physician and his patients, augmented by letters between the physician and other physicians on medical topics. On the other hand, it is a correspondence between the physician and other men of science on non-medical subjects (archaeology, botany, bibliophily, poetry, etc.).

Correspondence as Topic↗
PubMed2006

Physicians perception of health insurance in Saudi Arabia.

OBJECTIVE: To assess physicians views on health insurance and its implication on the health care system. METHODS: We carried out a cross-sectional study in 2 major hospitals in Riyadh, Kingdom of Saudi Arabia. Data were collected from January to December 2002 through self-administered questionnaires that were distributed to a total sample of 400 physicians. The instrument consisted of 28 items that focused on assessing physicians' perception towards health insurance and its effect on health services. We performed a descriptive statistics and analysis of variance using the Statistical Package for Social Sciences. RESULTS: Overall, 151 physicians (38%) completed the survey. This study clearly shows that access to health care services is a major concern; more than 94% of the respondents agree that everyone in the Kingdom should have access to healthcare services. Respondents also agree that health insurance will improve access to healthcare services for all citizens. Physicians also believed that health insurance would lead to more regulations and utilization review of services, create more competition between healthcare providers, and create new jobs in the healthcare sector. Saudi physicians reported a higher mean score for 11 items with significant p-values as compared with non-Saudi physicians. CONCLUSION: Physicians in this survey believed that accessibility is a major policy concern, and that health insurance will have a positive effect on access to the health care system. Yet, accessibility is an illusive term with many aspects that go beyond the identification of need for health care to the actual delivery of health care services and the organizational structures to match the needs of society. Cooperation as a national health system should be built on collaborative efforts rather than market competition in itself. It has been suggested that markets are stronger in the role of delivery than in the financing of health care, that markets tend to promote more expenditure on technological innovation rather than producing the most desired set of social outcomes. Cooperative health insurance can be an answer to the current problems facing the health care system in the Kingdom of Saudi Arabia as long as it remains cooperative rather than competitive.

Attitude of Health Personnel↗
PubMed1992

Creating a healthy public.

Significant change in thought and action will be required for our health system to become capable of serving all citizens effectively. Reliance on market forces and political expediency to shape health policy has focused attention inappropriately on finding ways to pay for illness care rather than maximizing health status. This misdirection of thought and effort has led many of us to search for ways to assure that health policy decisions are consistently based on both science and an ethic of humane concern. Courageous and disciplined local leadership will be needed to motivate policymakers to focus on the task of creating a healthy public. Linkage of academicians and practitioners with the public in a manner than empowers communities to assess and prioritize their own health problems could foster a strong community-based demand for ethical and humane decision making. Constituent demand for improved health status could provide the support politicians need if they are to legislate a national health program that emphasizes health promotion and disease prevention as well as illness care.

Forecasting↗
PubMed1979

[The mental patient as motorist. When is unfitness to drive involved? (author's transl)].

The bulk of road traffic accidents are not caused by ill drivers and even not at all by mentally ill drivers. So far as diseases are involved in the assessment of suitability to drive, the Joint Advisory Board for Medical Science relating to Traffic Safety and the Federal Minister for Youth, Family and Health have worked out standards for this. Examples were given and the principles were presented according to which expert opinions by doctors and specialists should be made. Otherwise difficulties arise in road traffic from the psychiatric point of view through the nonconformist behavior of the normal citizen who apparently finds it difficult to realize the principles of self-responsibility.

Accidents, Traffic↗
PubMed2004

Regenerating movements: embryonic stem cells and the politics of potentiality.

This paper develops a theoretical frame for analysing social movements in/and biomedicine. Drawing from work in social movement theory and science and technology studies, the paper describes the field of biotechnology as the material/imagined space of contemporary biopolitics in the contemporary United States. Interviews with activists from four social movements, websites and written material are examined, and two processes of knowledge construction were found to be central in constituting the field of biotechnology. These processes open up multiple sites for citizen participation in the construction of scientific knowledge.

Biomedical Research↗
PubMed2003

[Science in taking medicine].

It is a well-known fact that medicine plays an important role in treatment of several diseases. New development of many drugs led to not only benefits but also unexpected damage to human beings. In Japan, we are plunged into an aging society we have never experienced. We have far more opportunities to take medicine. Under these circumstances, it is very important for each one of us to learn how more reliable to take medicine to prevent unexpected side effects. In this citizen joint symposium, we focused on how to take medicine more logically and effectively from the viewpoint of patients. Participation in this symposium could hopefully help promoting our health care in Hokkaido.

Drug Therapy↗
PubMed2026

Beyond the clinic: a community-embedded, multidomain framework for early detection of glaucoma.

Glaucoma remains one of the leading causes of acquired irreversible blindness worldwide, with normal-tension glaucoma representing the dominant subtype in Japan and several East Asian populations. The insidious, asymptomatic progression of this condition, combined with the demonstrated inadequacy of intraocular pressure alone as a screening criterion, creates a critical gap between disease burden and case detection. Population-based epidemiological studies consistently reveal that the majority of individuals with glaucoma are undiagnosed. Two responses have been suggested: incorporation of retinal imaging into annual health checkups, which warrants formal prospective evaluation, and characterization of individuals at higher risk - integrating genomic risk, oxidative stress biomarkers, systemic lifestyle factors, and ocular blood flow dynamics - which may help identify those in whom damage is most likely to occur. The principal contribution of this Perspective is therefore the implementation model rather than the individual screening components. We introduce the Living Lab ('neighborhood health lab'), a community co-creation platform established under the Japan Science and Technology Agency COI-NEXT 'Vision to Connect' hub at Tohoku University, as a scalable model for operationalizing this framework. Embedded within commercial retail environments, the Living Lab integrates non-invasive screening, longitudinal health data collection, and evidence-based health product development-exemplified by the Ronbun Recipe® concept-within a stakeholder-aligned ecosystem encompassing citizens, researchers, industry, and municipal authorities. Conceived as a platform for well-being rather than as a disease-specific screening service, it engages individuals who are asymptomatic, undiagnosed, and outside existing screening pathways, and who would not otherwise be assessed at all.

Humans↗
PubMed1996

The Danish Conscription Registry: a resource for epidemiological research.

According to the Danish constitution all Danish male citizens must appear before a Conscript Board for assessment prior to military or civil service. Conscript Board examinations have followed the same standardized procedures over many decades, and the Danish Conscript Registry represents a valuable resource for epidemiological research in Denmark. During the last two decades investigations based on information in the registry have produced significant contributions to many areas of medical science. Within the last decade new procedures and electronic data processing and storage have resulted in restricted possibilities concerning current and future utilization of the Danish Conscript Registry for epidemiological purposes. To improve this it is recommended to maintain all codes describing present illnesses and conditions together with the civic registration numbers in the computerized archive of all subjects assessed by the Conscript Board.

Adolescent↗
PubMed2002

Implementing a mandatory geriatrics clerkship.

Due to the rapid growth in the proportion of U.S. citizens aged 65 and older (20% by 2030) it is imperative that U.S. medical schools train students who can provide quality care to the older population. Consequently, the objective of this paper is to report the experience of creating a 4-week, mandatory geriatrics clerkship for junior medical students. Funded by a grant from the Donald W. Reynolds Foundation, the University of Arkansas for Medical Sciences developed a mandatory, third-year clerkship in geriatric medicine. The clerkship included clinical experiences in outpatient clinics, transitional care units, nursing homes, hospice programs, and core didactic sessions. The sites for the clerkship were the University of Arkansas for Medical Sciences Hospital, the Central Arkansas Veterans Healthcare System Hospital, community nursing homes, and community hospice programs in Little Rock, Arkansas. The entire junior class of 135 students participated in the new clerkship. Students were assessed through a three-station Objective Structured Clinical Examination followed by a brief post- encounter examination and faculty preceptor evaluations collected from each clinical site. Students evaluated the clerkship through written evaluations and focus group discussions. This paper demonstrates that students acquired sufficient cognitive knowledge to satisfactorily complete the clerkship but did not highly value the experience.

Aged↗
PubMed2005

MMR--public policy in crisis: whose tragedy?

PURPOSE: To explore the issues surrounding the falling rates of MMR vaccination followingthe publication of a controversial study by Wakefield et al. DESIGN/METHODOLOGY/APPROACH: In order to take a fresh look at the MMR crisis, theGreek tragedy, Antigone, was used as a "strong plot" to de-contextualise the underlying social and political issues. In this short paper, two themes are explored that emerge from reading Antigone with respect to the unfolding crisis of public confidence in the MMR vaccine: first, the challenge to government inthe form of a decrease in public trust in government and government policies; and second, how such a challenge assumes significance and, arising from that, the question of how one might respond to the challenge. FINDINGS: The MMR debate throws issues of importance to society into relief--for example,public trust in government and science; and notions of public good versus rational choice in public policy on vaccination, However, much of the debate has been polarised into good versus evil--good and evil being subjective positions that are interchangeable, depending on the side one favours. It is argued that the issues are more complex than this, and are as much to do with political consent and the bargain between citizen and state. ORIGINALITY/VALUE: Using "strong plots" to theorise about current issues is powerful because it allows one to explore them from different angles and challenge one's understanding. Antigone provides us with a way of standing back from the MMR crisis and re-conceptualising the issues to capture the essence of the underlying debate.

Child↗
PubMed2002

[Science in atherosclerosis].

Ischemic heart disease and cerebral vascular accident are major cause of death in Japan. Development of these diseases is based on atherosclerosis, which would become evident in the middle-aged. Atherosclerosis is a process of aging, because its progression is closely associated with increase in age. Other factors such as smoking, eating habits and obesity are known to facilitate it. Therefore, it is very important for each one of us to learn the risk factors of atherosclerosis and to prevent it by paying attention to our life style. In this citizen joint symposium, we focused on the strategy for treatment and prevention of atherosclerosis by summarizing its mechanisms and consequences. Participation in the symposium could hopefully stimulate our civil activities against atherosclerosis and help promoting our health care in Hokkaido.

Arteriosclerosis↗
PubMed1998

On the one aspect of generalized anxiety.

Generalized anxiety disorder, considered to be a theoretical and psychopathological construct in the Western world, has emerged as an endemic daily problem in the post-Soviet republics. The daily uncertainties of life have become such a burden for most citizens of these countries that even clinical scientists in these countries have largely abandoned the study of this condition. Left to the politicians in the leadership of these republics, little alleviation has come by way of 'social therapies'. The author of this article, who is assigned to the Office of the President of the Republic of Armenia, proposes that much is to be gained by both science and society if scientists from western and newly independent states jointly study the phenomenology of generalized anxiety in these states.

Anomie↗
PubMed1992

[Health Councils: assessment after 1 year of functioning].

OBJECTIVE: Analysis of the experience from creating and developing Health Committees in the areas of Santa Maria de Gracia and La Nora (Murcia) throughout more than one year in operation (1989-90), as bodies for community participation. DESIGN: Participative research which has meant the transformation of existing reality, and which in the process has been a source of knowledge. LOCATION: Clinic Centres, at community level, in two basic health areas, one rural and one urban. PARTICIPANTS: E.A.P., education officers, pharmacists, various associations, mayors, the Government, Department of Socio-health Sciences of the Faculty of Medicine, and the community in general. INTERVENTIONS: The analysis of developing the participative dynamics. MAIN RESULTS: The content of the Minutes of the meetings were analysed in order to give an objective, systematic and quantitative view of what has occurred, 22 variables were identified which were grouped and cross grouped. CONCLUSIONS: Everyone is invited to the Committees and the large majority attend. Citizens and professionals speak and express their views. The meetings are democratic and agreements are reached, objectives established, health problems are resolved and the only instrument used being participation. This has all been stable throughout the year of operation.

Health Planning Councils↗
PubMedDate not supplied

Too many applicants for available graduate medical education positions--are we on a collision course?

Until the last few years, graduate medical education (GME) positions were so plentiful in the United States that even with a heavy influx of both U.S. and alien graduates of foreign medical schools, many positions remained unfilled. In the future, however, it is unlikely that all those planning to enter GME in the United States will be able to do so. Applicants for U.S. GME positions increased from 15,000 in 1980 to 20,000 in 1983, while the positions offered declined to fewer than 18,000. Increasing financial pressure may cause some U.S. hospitals to cut back on their GME positions. Recent Federal regulations require them to isolate the cost of education from patient care costs, and community hospitals may no longer with to provide GME if they can no longer recover educational costs. On the other hand, State legislatures may react to pressures to provide GME positions for U.S. citizens graduating from foreign medical schools. Another factor increasing the demand for GME positions is the greater number of U.S.-citizen graduates from foreign medical schools in the Caribbean. The Caribbean schools generally lack the facilities to provide clinical training, so that efforts are made to provide such training for U.S. citizens in the United States. For example, it has been reported that opportunities for two to five thousand clerical clerkships exist in New York State. Alien and U.S. graduates of foreign medical schools have been required to take different examinations to qualify for GME in the United States, but beginning in 1984, both groups will be required to pass a new Foreign Medical Graduate Examination in the Medical Sciences. Ways are also being sought to assess the clinical skills of these graduates. It is hoped that an equitable system to evaluate all foreign medical graduates will soon be in place, so that those who meet standards comparable to the ones required of U.S. medical students will be able to enter U.S. graduate medical education programs.

Education, Medical, Graduate↗
PubMed2006

Lessons from history: why race and ethnicity have played a major role in biomedical research.

Before any citizen enters the role of scientist, medical practitioner, lawyer, epidemiologist, and so on, each and all grow up in a society in which the categories of human differentiation are folk categories that organize perceptions, relations, and behavior. That was true during slavery, during Reconstruction, the eugenics period, the two World Wars, and is no less true today. While every period understandably claims to transcend those categories, medicine, law, and science are profoundly and demonstrably influenced by the embedded folk notions of race and ethnicity.

Black or African American↗
PubMed2003

A fertile mother Russia: pronatalist propaganda in revolutionary Russia.

The Soviet consultation with its attendant propaganda, visiting nurses, and vacation homes attempted to set science and the doctor as the ultimate authority in matters of child rearing in place of old authorities, deny the contention that motherhood was a natural ability of women, and take over the father's place in the home. Soviet health care policy bridges pre- and postrevolutionary thought, blurred the boundaries between public and private, and mirrored international natalist policies. However, the application of these policies conformed to Soviet concepts of citizens' duties and state imperatives.

Child↗
PubMed2005

Understanding of genetic information in higher secondary students in northeast India and the implications for genetics education.

Since the work of Watson and Crick in the mid-1950s, the science of genetics has become increasingly molecular. The development of recombinant DNA technologies by the agricultural and pharmaceutical industries led to the introduction of genetically modified organisms (GMOs). By the end of the twentieth century, reports of animal cloning and recent completion of the Human Genome Project (HGP), as well techniques developed for DNA fingerprinting, gene therapy and others, raised important ethical and social issues about the applications of such technologies. For citizens to understand these issues, appropriate genetics education is needed in schools. A good foundation in genetics also requires knowledge and understanding of topics such as structure and function of cells, cell division, and reproduction. Studies at the international level report poor understanding by students of genetics and genetic technologies, with widespread misconceptions at various levels. Similar studies were nearly absent in India. In this study, I examine Indian higher secondary students' understanding of genetic information related to cells and transmission of genetic information during reproduction. Although preliminary in nature, the results provide cause for concern over the status of genetics education in India. The nature of students' conceptual understandings and possible reasons for the observed lack of understanding are discussed.

Cells↗