Public health and public medical care

This paper deals briefly with the historical development of the major movements and organizations dedicated to the preservation of the health and security of the American people. Statements of various national organizations on the need for integration of these various services for the protection of the indigent are presented, and the experience of one county department in San Mateo which operates a completely integrated department of public health and welfare is reviewed, giving the pros and cons of the operation of a number of disciplines through a single administration. The major advantage of an integrated department of this kind is that all the services having to do with human needs-the needs arising from emotional distress, economic reverses or illness-are combined under the direction of a physician. It is probable that failure of the health discipline to provide such services was a factor in the presentation of the Wagner Act in 1938 and the Wagner-Murray-Dingell Bill in 1943. Continued close cooperation between the various disciplines devoted to the protection of the health and welfare of American citizens can help in solving some of the current problems.     

Canadian medical schools before ACMC.

The earliest medical schools were established to supplement apprenticeship, the only route to practice available in colonial Canada. By 1885, eight medical schools were trying to accommodate the volume of new scientific information flowing from Europe. In 1910, when Flexner evaluated the schools against the Johns Hopkins model, some were woefully deficient, but by 1928 all had achieved Class A rating. The 1921 discovery of insulin in Toronto gave impetus to scientific research and, possibly, influenced the formation and funding of the National Research Council in 1934. Clinical specialization expanded, leading in 1929 to the establishment of the Royal College of Physicians and Surgeons of Canada to accredit training and certify graduates. The Association of Canadian Medical Colleges was formed at a meeting of deans to discuss a federal offer of funding and to accelerate the graduation of physicians for the war effort.     

Hepatitis B virus infection in medical and health care personnel.

Analysis of 51 cases of hepatitis B virus infection in health care workers admitted as patients to the liver unit over seven years showed three healthy carriers of hepatitis B virus, seven cases of fulminant hepatic persistent hepatitis, 17 cases of chronic active hepatitis (of whom 11 had cirrhosis), and five cases of hepatocellular carcinoma. To date 11 of these patients have died. Only 15 of the 51 patients had a history of direct occupational exposure and only three patients could recall specific inoculation injuries. In contrast, the source of infection was apparent in 32 of 50 consecutive cases of fulminant hepatic failure or acute hepatitis B in nonmedical staff. Since specific inoculation injuries are not the usual mode of infection ion medical staff and since only a few of the patients who are hepatitis B virus carriers will be detected by selective screening of "high-risk" patients, the overall risk of infection can be reduced only by stricter precautions in the handling of any patient''s blood and by the use of hepatitis B virus vaccines for medical staff at high risk.     

Canada's medical schools

A 20-year-old man with a 10-year history of glomerulonephritis presented with a purpuric rash on his legs. A renal biopsy specimen obtained when he was 11 years old had shown mesangial glomerulonephritis; staining 9 years later for IgA had negative results. A second renal biopsy, performed when the rash was present, revealed mesangial glomerulonephritis and mesangial deposits of IgA; biopsies of the involved skin showed leukocytoclastic vasculitis. In this case isolated glomerulonephritis appeared to change to a multisystem illness, with a different immunologic character, through one of several possible pathogenetic mechanisms.     

Socioeconomic and demographic correlates of medical care and health practices

using a 2-stage stratified sampling procedure, a random sample of 1021 rural families in North Arcot District of Tamil Nadu State in South India was studied to determine the interrelationships of utilization of medical care and health behavior with social, demographic and economic factors. Distance from a town, education, and accessibility of medical facilities seem to play a prominent role in the various decision making processes. 81.5% of respondents preferred only home treatment for common ailments at the initial stages of the disease. Of the remainder 1/2 preferred to go to a hospital and the other 1/2 chose a qualified physician. If the ailment persisted, 53% preferred to go to a hospital and 43% to a physician. The 1st choice for outside medical care for 44.8% of the respondents was a private medical practitioner, for 42.9% it was the government hospital and for the remaining 11.4% it was a nearly clinic or private hospital. In 88% of the cases, the head of the household met all the expenses. In only 4% of the cases were the expenses met by the employer or through another arrangement. Nearly 2/3 of the respondents agreed and 2i% disagreed that treatment would be better if provided free of cost and most thought it would be improved if health facilities were situated within the village itself. At the initial stages of common ailments some 90% of those residing within 5 km from a town said that they would treat themselves at home. If the ailment persisted, 52.4% preferred to go to the hospital and 43.7% to approach a physician. Only 63.7% of those living beyond 10 km from town preferred home treatment during early stages, and when the ailment persisted, 45% preferred the hospital while 55% preferred to approach a physician. 90% of respondents with lower incomes preferred home treatment for common ailments in the initial stages, compared to 56% of those with higher incomes. The proportion choosing a private medical practitioner as the 1st choice is much lower in the lowest income groups than in the highest income group. Those in the upper income groups preferred the source of medical care where they could get quick relief; lower income groups preferred the source of free services. The proportion who said they would approach a physician even during the initial stages of ailments increased significantly with education. The proportion whose 1st choice was a government hospital declined as education increased.     

Faculty development practices in Canadian medical schools.

Twelve Canadian medical schools that had an organized faculty development program were surveyed to evaluate the extent to which such programs were used and to estimate their effectiveness. Common practices included sabbaticals and programs designed to improve instructional skills. The main problems included underfunding, poor participation and inadequate instructor evaluation.