C.-E.A. Winslow and the later years of public health at Yale, 1940-1945

This paper is one of a series of papers in which I consider contemporary Yale medical education in general and the Yale Department of Epidemiology and Public Health in particular. It tells of the retirement in 1945 of C.-E.A. Winslow, Professor and Chairman of the Yale Department of Public Health since its inception in 1915; of the committees established by the dean of the School of Medicine and the president of the University, charged with determining the future direction of the department; and of the outcome, which, in 1945, proved favorable to Winslow's public health philosophy in contrast to the medical school's clinical needs and desires.     

A Conversation About Health Care Reform

Professor Victor R. Fuchs is the Henry J. Kaiser Jr Professor at Stanford (California) University, where he applies economic analysis to social problems of national concern, with special emphasis on health and medical care. He holds joint appointments in the Economics Department and the School of Medicine''s Department of Health Research and Policy. Professor Fuchs is a Distinguished Fellow of the American Economic Association and a member of the American Philosophical Society, the American Academy of Arts and Sciences, and the Institute of Medicine of the National Academy of Sciences. He was the first economist to receive the Distinguished Investigator Award of the Association for Health Services Research and has also received the Baxter Foundation Health Services Research Prize. Professor Fuchs is president-elect of the American Economic Association. His latest book, The Future of Health Policy, was published by Harvard University Press in 1993.The following edited conversation between Professor Fuchs and Linda Hawes Clever, MD, Editor of the journal, took place on April 8, 1994.     

Ergonomics policy in Indonesia

Workers' conditions in accordance with their place of work are different from one area to another, especially in this reformation era where there are immense alterations in politics shown from the centralized government shifting to decentralization and district autonomy. Ergonomics problems in Indonesia are reviewed. In home industries, workers have to adjust themselves to their jobs, and ergonomic improvement may face significant impediments especially in small-scale industries. It is necessary to create or identify the most plausible model to be implemented in accordance with the conditions of districts, including low awareness about the relation between ergonomics and workers' productivity in producing goods and services and working processes scattered often at their own houses. As conditions conducive to ergonomics programs, district-level willingness to improve and increase the wealth of their society, recognition by businesses about the impacts of ergonomics on productivity and reduction of medical treatment costs may be mentioned. Labor unions support ergonomic improvements at production processes, and professionals and academicians are ready to assist, whereas national banks and foreign investment may encourage new technologies including ergonomics aspects. It is important to strengthen ergonomic improvement efforts in Indonesia through establishing district ergonomics improvement networks and ergonomics peer leaders with the support of continual training starting from the training of core leaders at the province level and extending to peer leaders at district level. This training should be made as simple as possible in order to facilitate innovations toward changes. Finally assistance is needed by the mentor teams in order to periodically monitor the improvements undertaken.     

Ergonomics for occupational hygienists in developing countries with examples from Sri Lanka.

Occupational health problems in developing countries, especially those situated in the tropical zone, are difficult to define. The conditions are more adverse in unorganized small-scale industries. The application of ergonomic principles in the practice of occupational health in developing countries must be subject to all aspects of community health and impact of industrialization as well. Ergonomics offers a broad concept to health scientists in developing countries. "Systems ergonomics" is not applicable. On the contrary, the fact that ergonomics conveys a different meaning to those in developing countries is highlighted by a few examples from Sri Lanka. The author presents his view for consideration in the development of international instruments to prescribe the sale of guarded machinery to developing countries and the limitation of incentive schemes for performing arduous tasks leading to occupational illnesses.     

Introducing Indonesian Medical Students to Rainforest Conservation and Community Health in the Field: A Practicum Experience in East Kalimantan

This article describes a practicum experience developed between a conservation organization (The Nature Conservancy) and a medical school (The Faculty of Medicine at Mulawarman University in East Kalimantan). Through this practicum, groups of medical students from Mulawarman have assisted with baseline and follow-up community evaluations in remote villages along the Kelay River, Berau District. These evaluations were done in conjunction with the Kelay Conservation Health Program, a program designed to improve health and healthcare for local people, mostly former hunter–gatherers, in an area of rainforest that the conservation organization seeks to protect. Besides gaining experience in community health assessment, through this practicum medical students also gained field experience and knowledge in rural and remote area health and healthcare in Indonesia and had an opportunity to explore linkages between conservation and health. At the conclusion of their time with the program, participating students also presented individual problem-based reports on relevant topics to students and faculty at the Medical School and to the District Health Department. This partnership between a conservation agency and a medical school in a developing country is unusual, but has been very well received by all stakeholders involved. Because of this, Mulawarman is now planning to make Kelay into a formal training site for its students. This experience may serve as a model for other groups interested in promoting ecosystem health education to future health professionals in the developing world.     

NHS waiting list have been a boon for private medicine in the UK.

Health care: public, private or both? In Great Britain, about 13% of the population is covered by private health insurance, and everyone else is served by the public health care system known as the National Health Service, or NHS. Caroline Richmond, who examined the impact of private medical practice in Britain, says people become private patients for one compelling reason: to avoid the NHS''s notoriously long waiting lists for surgery. According to Professor Alan Maynard, a health care researcher, the mainstays of the private sector are the "three h''s" --hips, hernias and hemorrhoids-- along with some elective surgery, particularly in gynecology and opthalmology. Another small sector focuses on fertility regulation and cosmetic surgery. Although the levels are not monitored closely, physician consultants are not permitted to earn more than 10% of their income from private practice.     

Health departments in the U.S. 1920-1988: statements of mission with special reference to the role of C.-E.A. Winslow.

The mission of local health departments in the U.S. is traced from the 1920s to the present through examination of official promulgations of the American Public Health Association and other organizations. As the communicable diseases came under general control, this mission was conceived more broadly. Nevertheless, in effect their public health role was diminished due to the rapid ascendancy of private and not-for-profit medical care, which consistently sought to keep public health out of potential areas of competition. Thinking both within the public health field (as represented by C.-E.A. Winslow) and outside the public health field (as represented by the American Medical Association), had created boundaries limiting public health's role to preventive medical services. This restriction, in turn, largely excluded the public health field from participation in the tremendous expansion of medical care since World War II. The public health role was further limited in 1970 by the removal of much of environmental pollution from its purview. The sum of these and other forces has left the public health field weakened and in considerable confusion about its role at a time when the resurgence of infectious disease (e.g., AIDS and Lyme disease), environmental hazards, and medical care institutions requires a strong public health presence.     

A World Health Organization primer

The World Health Organization (WHO) can be considered the primary agency of the United Nations that promotes global public health. This article provides a general overview of WHO by exploring the history, current, and future practices of the organization, and by addressing its major roles and functions in the present day. BACKGROUND: Srimathy Vijayan is a fourth-year medical student at the University of East Anglia, Norwich, United Kingdom. She interned at the WHO headquarters in Geneva during the summer of 2007.     

Hufeland's interest in plant movements.

Christoph Wilhelm Hufeland (1762-1836) was one of the eminent physicians at the time of Goethe. When only 21 years old, he followed his father as a medical practitioner in Weimar. In 1793 he became Professor of Medicine at the University of Jena, from where he moved, in 1801, to Berlin as the physician in ordinary to king Friedrich Wilhelm III, council of state, and Professor at the leading hospital, the Charité. Hufeland pioneered in what today would be called public hygiene. Many of his lectures and publications were addressed to the educated laymen. In his most read book, the 'Makrobiotik', he emphasizes the importance of the 24-h periodicity as a basic unit of biological chronometry. In view of this, Hufeland has become a kind of 'patron saint' to modern chronobiologists.     

Ergonomics--future directions

The International Ergonomics Association plays a leadership role in shaping the future of ergonomics. Having formed nearly 50 years ago for researchers to meet and exchange their findings, it still provides a wide range of opportunities for promoting research and teaching. In 2006, the IEA is also an outward looking organisation with linkages to governments, international agencies and other professional associations. We have many opportunities to extend our engagement with industry and the community through the IEA communication strategy and Technical Committees. Whilst the IEA now has 20 Technical Committees that demonstrate the diversity of ergonomics research there is a growing trend towards integration of specialist areas. The emergence of a holistic approach to research and application of ergonomics is making a new direction for the ergonomics profession. Apart from the role of a technical specialist, the Ergonomist is also a team member with a range of other stakeholders. To be effective in practice, the Ergonomist needs to be a good communicator and "agent of change" who can mentor others to develop simple cost effective interventions. Research is fundamental to the science of ergonomics. Evaluation of interventions remains a major component of future ergonomics research. Sustainable positive outcomes based on a holistic approach will result in a broad uptake of ergonomics findings. In industry future challenges relating to psychological health in developed countries and the informal sector in developing countries are emerging as new areas for research and application of ergonomics.     

医学生突发公共卫生事件应对知信行调查

目的：了解医学生突发公共卫生事件相关知识、态度、行为现状,为制订干预措施提供依据。方法：采用多阶段抽样方法,共抽取某医学院1380名本、专科学生进行突发公共卫生事件知、信、行问卷调查。结果：突发公共卫生事件相关知识平均得分为（35.93±6.98）,总体知晓率为71.54%。其中女生高于男生（P=0.000）,本科生高于专科生（P〈0.000）,外省生源高于本省生源（P=0.001）,年级越高得分有增高的趋势（P=0.000）。40.8%的学生对突发公共卫生事件感到恐惧;80.0%的海医学生愿意了解突发公共卫生事件相关知识,并认为学校有必要开设相关课程及进行应急演练;仅有17.2%的学生曾和家人讨论过如何应对灾害事件,91.5%的学生从未与家人进行过逃生演练。结论：医学生对突发公共卫生事件相关知识掌握不全面,部分学生尚未建立正向的认知态度和健康的行为方式,学校应采取适当的方式加强突发事件知识和技能的训练。     

Some observations on the needs of ergonomics in industries in Hong Kong.

The author's interest in ergonomics lies in the common ground it shares with occupational health, since ergonomics aims to make work easier, safer, and more productive and to promote efficiency, comfort, and health. In Hong Kong, owing to lack of natural resources and guaranteed markets, industrialization has not taken a smooth course. Only light industries exist, and one industry flourishes after another. Occupational health and safety tends to be neglected not only by the employers but by the employees. The government becomes the promoter of labor legislation. There is almost no information on occupational diseases. There are some elementary official statistics on occupational accidents. There is practically no research activities on this area going on. There is a very critical lack of occupational health, workers in Hong Kong. Ergonomics may help in improving the present situation because its aims are more positive to the industrialists and the workers who should be converted into educated consumers of ergonomics. In the long run, advancement in occupational health and safety practice will be made.     

Quackery versus professionalism? Characters,places and media of medical knowledge in eighteenth-century Hungary

This essay discusses the question of health in the Kingdom of Hungary during the Age of Enlightenment. It explores the relationships and tensions between central theories of medical police and the local expectations of government administrators, as well as those between academic or official knowledge and implicit or alternative knowledge about health. The reigns of Maria Theresia and Joseph II marked the moment at which particular kinds of folk and practical knowledge about healing became visible and above all legible. This is to be seen in the enormous rise in book production, which in itself represented an 'approved knowledge' that found legitimation in new academic and bureaucratic institutions, such as the reformed medical faculty of the University of Vienna, the newly-founded medical faculty at Tyrnau, the establishment of a health department within the Hungarian Statthalterei, as well as in the emission of royal legislation supporting the agendas of the new enlightened science of 'medical police'.     

Drivers of Physicians’ Engagement in Addressing Eco-health Problems

Physicians are in a unique position to be first-hand observers of the effects of environmental factors on population health. As a source of information which is highly trusted, they are also well-suited to raise awareness about the linkages between ecosystem and population health. Yet, current clinical practice in many parts of the world rarely includes environmental health assessments and patient education. The empirical evidence on the reasons for this lack of engagement is limited by the small number of studies published, its narrow geographical scope and the dearth of multivariate statistical analysis. This study used a mixed-methods approach to investigate the determinants of whether physicians at selected hospitals in Thailand assess the environmental history of their patients and provide environmental health advice. Using an ordered logistic regression model, it was found that physicians’ engagement was associated with their knowledge, personal motivation, perception of being supported by senior staff and ability to discuss with colleagues. According to key informants, possible remedies for the observed lack of physicians’ engagement include revisions of the medical school curriculum, clear strategies for addressing eco-health linkages in the clinical context at the national and hospital level, and better cooperation between relevant government institutions in Thailand.     

James F. Crow: his life in public service

The readers of this journal may well be aware of Professor Crow's scientific achievements and his role as the editor of Perspectives. In addition, for many thousands of students at the University of Wisconsin over many generations, James F. Crow was one of the most memorable teachers at both the undergraduate and graduate levels. What is less known is his major role in public service where he served as chair of many important committees for the National Academy of Sciences, the National Institutes of Health, the National Institutes of Justice as well as various international programs. In all of these efforts, Professor Crow has left a lasting impact.     

Knowledge Levels and Training Needs of Disaster Medicine among Health Professionals,Medical Students,and Local Residents in Shanghai,China

Background

Disaster is a serious public health issue. Health professionals and community residents are main players in disaster responses but their knowledge levels of disaster medicine are not readily available. This study aimed to evaluate knowledge levels and training needs of disaster medicine among potential disaster responders and presented a necessity to popularize disaster medicine education.

Methods

A self-reporting questionnaire survey on knowledge level and training needs of disaster medicine was conducted in Shanghai, China, in 2012. A total of randomly selected 547 health professionals, 456 medical students, and 1,526 local residents provided intact information. The total response rate was 93.7%.

Results

Overall, 1.3% of these participants have received systematic disaster medicine training. News media (87.1%) was the most common channel to acquire disaster medicine knowledge. Although health professionals were more knowledgeable than community residents, their knowledge structure of disaster medicine was not intact. Medical teachers were more knowledgeable than medical practitioners and health administrators (p = 0.002). Clinicians performed better than public health physicians (p<0.001), whereas public health students performed better than clinical medical students (p<0.001). In community residents, education background significantly affected the knowledge level on disaster medicine (p<0.001). Training needs of disaster medicine were generally high among the surveyed. ‘Lecture’ and ‘practical training’ were preferred teaching methods. The selected key and interested contents on disaster medicine training were similar between health professionals and medical students, while the priorities chosen by local residents were quite different from health professionals and medical students (p<0.001).

Conclusions

Traditional clinical-oriented medical education might lead to a huge gap between the knowledge level on disaster medicine and the current needs of disaster preparedness. Continuing medical education and public education plans on disaster medicine via media should be practice-oriented, and selectively applied to different populations and take the knowledge levels and training needs into consideration.     

"C.-E.A. Winslow and the early years of public health at Yale, 1915-1925"

C.-E.A. Winslow was the first chairman of the Department of Public Health at the Yale University School of Medicine. This paper considers the development and changing agenda of his department, the structure of Yale University, and the maturation of public health as a discipline. Winslow's successes and failures are discussed as they relate to Yale and external societal influences.     

The Global Crisis of Malaria: Report on a Yale Conference

An international conference, “The Global Crisis of Malaria: Lessons of the Past and Future Prospects,” met at Yale University, November 7-9, 2008. The symposium was organized by Professor Frank Snowden and sponsored by the Provost’s office, the MacMillan Center, the Program in the History of Science and History of Medicine, and the Section of the History of Medicine at the Yale School of Medicine. It brought together experts on malaria from a variety of disciplines, countries, and experiences — physicians, research scientists, historians of medicine, public health officials, and representatives of several non-governmental organizations (NGOs). An underlying theme was that much could be gained from a big-picture examination across disciplinary frontiers of the contemporary public health problem caused by malaria. Particular features of the conference were its intense scrutiny of historical successes and failures in malaria control and its demonstration of the relevance of history to policy discussions in the field.     

Ethical Study on the Reform and Development of Medical and Health Services in China

At an early stage of its foundation, new China became clear about the nature of public welfare and quickly developed medical and health services, which was well received by the World Health Organization. The marketization and the reduction of input into medical and health services from the 1980s created severe adverse consequences. After the SARS' outbreak in 2003, China started to give serious consideration to its medical and health system, and to work at developing medical and health services. The new healthcare reform launched in 2009 re‐emphasizes fairness and public welfare, and China's achievements have been remarkable. Of course, there are still many problems to be solved in the reform, which also paves the way for increasing the reform in future.     

POLESAT : e-Atlas de santé, planification et développement durable

New knowledge come from detailed hospital activity of the French Medical Information System (PMSI). They allow doing health geography studies in geo-epidemiology, planning and healthcare uses to answer specific Public Health problems. Through our geomatics platform, we aim to give new scientific knowledge and reflection to healthcare professionals and the public thanks to geographical information and geographical analysis. The geographical studies are carried out at several division levels (postal-PMSI zones, proximity zones etc.) in the French Nord–Pas-de-Calais region of four million of inhabitants. In order to improve information, decision-making, and in tandem with each user's rhythm, we will provide access, transmission, communication and information of the geographical studies through our first tool of Health e-Atlas.