Medical ethics and education for social responsibility.

The physician, said Henry Sigerist in 1940, has been acquiring an increasingly social role. For centuries, however, codes of medical ethics have concentrated on proper behavior toward individual patients and almost ignored the doctor''s responsibilities to society. Major health service reforms have come principally from motivated lay leadership and citizen groups. Private physicians have been largely hostile toward movements to equalize the economic access for people to medical care and improve the supply and distribution of doctors. Medical practice in America and throughout the world has become seriously commercialized. In response, governments have applied various strategies to constrain physicians and induce more socially responsible behavior. But such external pressures should not be necessary if a broad socially oriented code of medical ethics were followed. Health care system changes would be most effective, but medical education could be thoroughly recast to clarify community health problems and policies required to meet them. Sigerist proposed such a new medical curriculum in 1941; if it had been introduced, a social code of medical ethics would not now seem utopian. An international conference might well be convened to consider how physicians should be educated to reach the inspiring goals of the World Health Organization.     

The Association of Types of Training and Practice Settings with Doctors’ Empathy and Patient Enablement among Patients with Chronic Illness in Hong Kong

Background

The increase in non-communicable disease (NCD) is becoming a global health problem and there is an increasing need for primary care doctors to look after these patients although whether family doctors are adequately trained and prepared is unknown.

Objective

This study aimed to determine if doctors with family medicine (FM) training are associated with enhanced empathy in consultation and enablement for patients with chronic illness as compared to doctors with internal medicine training or without any postgraduate training in different clinic settings.

Methods

This was a cross-sectional questionnaire survey using the validated Chinese version of the Consultation and Relational Empathy (CARE) Measure as well as Patient Enablement Instrument (PEI) for evaluation of quality and outcome of care. 14 doctors from hospital specialist clinics (7 with family medicine training, and 7 with internal medicine training) and 13 doctors from primary care clinics (7 with family medicine training, and 6 without specialist training) were recruited. In total, they consulted 823 patients with chronic illness. The CARE Measure and PEI scores were compared amongst doctors in these clinics with different training background: family medicine training, internal medicine training and those without specialist training. Generalized estimation equation (GEE) was used to account for cluster effects of patients nested with doctors.

Results

Within similar clinic settings, FM trained doctors had higher CARE score than doctors with no FM training. In hospital clinics, the difference of the mean CARE score for doctors who had family medicine training (39.2, SD = 7.04) and internal medicine training (35.5, SD = 8.92) was statistically significant after adjusting for consultation time and gender of the patient. In the community care clinics, the mean CARE score for doctors with family medicine training and those without specialist training were 32.1 (SD = 7.95) and 29.2 (SD = 7.43) respectively, but the difference was not found to be significant. For PEI, patients receiving care from doctors in the hospital clinics scored significantly higher than those in the community clinics, but there was no significant difference in PEI between patients receiving care from doctors with different training backgrounds within similar clinic setting.

Conclusion

Family medicine training was associated with higher patient perceived empathy for chronic illness patients in the hospital clinics. Patient enablement appeared to be associated with clinic settings but not doctors’ training background. Training in family medicine and a clinic environment that enables more patient doctor time might help in enhancing doctors’ empathy and enablement for chronic illness patients.     

The use of zootherapeutics in folk veterinary medicine in the district of Cubati, Paraíba State, Brazil

Background

Viewed through the micro focus of an interpretive lens, medical anthropology remains mystified because interpretivist explanations seriously downplay the given context in which individual health seeking-behaviours occur. This paper draws upon both the interpretivist and political economy perspectives to reflect on the ethno medical practices within the Korean-Australian community in Sydney.

Methods

We draw on research data collected between 1995 and 1997 for an earlier study of the use of biomedical and traditional medicine by Korean-Australians in Sydney. A total of 120 interviews were conducted with a range of participants, including biomedical doctors, traditional health professionals, Korean community leaders and Korean migrants representing a range of socio-economic backgrounds and migration patterns.

Results and Discussion

First, the paper highlights the extent to which the social location of migrants in a host society alters or restructures their initial cultural practices they bring with them. Second, taking hanbang medicine in the Korean-Australian community as an illustrative case, the paper explores the transformation of the dominant biomedicine in Australia as a result of the influx of ethnomedicine in the era of global capitalism and global movement.

Conclusion

In seeking to explain the popularity and supply of alternative health care, it is important to go beyond the culture of each kind of health care itself and to take into consideration the changes occurring at societal, national and global levels as well as consequential individual response to the changes. New social conditions influence the choice of health care methods, including herbal/alternative medicine, health foods and what are often called New Age therapies.     

Pasteurella multocida infection from a cougar bite. A review of cougar attacks.

A serious shortage of nurses has developed since 1984 despite a growing number of employed nurses and a substantial decline in the number of hospital inpatient days. The evidence suggests that the shortage is the result of an increased demand for nurses, not a decline in supply. The increased demand in large part has resulted from the substitution of registered nurses for licensed practical nurses, aides, and other patient services personnel. The substitution was feasible because nurses'' wages have been depressed compared with those of other hospital employees. The shortage is likely to abate if nurses'' wages increase, making substitution more costly. Even in the absence of continuing wage increases, hospitals could ease the shortage by restructuring patient services and enabling nurses to spend a greater portion of their time in direct patient care.     

Observations on Accommodation for the Mentally Retarded in the Province of Ontario

Mentally retarded subjects occupy 8629 beds, a supply rate of 138 beds per 100,000 population. At this rate, and without overcrowding, another 2500 beds will be required by 1972, if the present rate of population increase is maintained. England has a lower rate of supply, but nevertheless the demand for beds, judging by waiting lists and waiting time, is greater in Ontario. A number of factors determining demand, such as family size, public attitude, professional advice and economic factors, may differ in the two communities. Two important differences are the more adequate community service and the availability of short-term care in England, which may reduce demand for permanent care. Since policy in developing community services may influence demand for accommodation, planning should take account of this. Planning well ahead is particularly important for a rapidly expanding population.     

Occupational health hazards resulting from elevated work rate situations.

Some occupational health hazards resulting from an elevated rate of work due to recent mechanization and automatization are discussed on the basis of results of health examinations. A rapid increase of a cervicobrachial disorder among young cash register and packing machine operators has been observed. Switching to the use of electronic cash registers has been shown to have only limited efficacy due to increased operation speed, and high-speed complex finger and hand movements of packer operators have also proven to be as hazardous as key-board operations. The high incidence of low-back pain, in particular gradually developing pain, among workers in electric power supply work has been suggested to be the result of quick and intensified work to meet increasing supply demand. Likewise, the workload of electric locomotive and bullet train drivers has increased in accordance with increased train speeds, and has been shown to have had significant effects on their health particularly in regards to neural strain, intra-cab environment such as air pressure change, vibration, and noise, and rotation on irregular shifts. New steps seem required therefore to meet the new health problems arising from a combination of modern technological changes and elevated working speeds.     

景感生态学视角下的健康社区构建

景感生态学是基于中国传统人居环境营造理论与实践结合现代生态学基本原理形成的新兴学科,注重探讨生态系统服务与可持续发展的关系。可持续发展目标中健康与福祉是其重要内容,因此健康人居环境的营造也是景感生态学的重要应用领域之一。在健康人居环境的营造过程中,健康社区构建具有作为"细胞工程"的基础性作用。因此,从景感生态学的视角探讨健康社区的构建,有助于景感生态学进一步应用于可持续发展与人居环境营造的实践,为健康与福祉的顺利实现提供支撑。从健康社区的定义和主要理念出发,基于健康社区构建的需求本体和供给客体及其相互作用关系,结合生态环境科学的"时-空-量-序"的视角,探讨了生态环境研究应用于健康社区构建的作用及面临的系统性不足、人文性不足和耦合性不足等挑战;进而以景感生态学作为连接生态环境学科与建筑规划学科的纽带,探讨了景感生态学在应对上述挑战中的作用。从景感生态学视角来看,健康社区构建就是将人类健康这一愿景融入到社区健康需求本体与健康供给客体及其相互关系的调控与营造,从而实现社区及人群的健康和可持续发展。健康社区的构建强调社区人群主观健康需求与客观健康供给之间的互动与耦合,与景感生态学强调"景"与"感"相互融合、相互作用具有高度一致性。本文从景感生态学的研究要素、景感营造的理念与研究工具等方面,系统地提出景感生态学视角下的健康社区构建框架：包括融合多景感要素的社区人群健康生态系统服务体系、营造多景感载体的社区人群健康行为意识引导体系和建设多方位的健康社区趋善化管理与智能感知体系。景感生态学所提供的崭新视角和系统性思路,对于健康社区的构建将具有重要的指导作用。     

Over the counter drugs. The interface between the community pharmacist and patients.

Pharmacists play an important part in primary health care, and their accessibility is a key factor. Their NHS payments relate predominantly to the dispensing of prescribed medicines; to recognise the service element of their advisory role, an NHS funded professional fee could be built into the cost structure for pharmacy medicines. The increased number of medicines available over the counter has highlighted the need for training for counter assistants; it will become compulsory in July 1996, and some family health services authorities are providing this. The shift to care in the community could mean that pharmacists will have an even greater role in the primary health care team. Encouraging the public to seek advice from the community pharmacist may lead to a greater proportion of visits to doctors resulting from referrals from the pharmacist. Joint development by pharmacists and doctors of guidelines for advice on, and recommendation of, over the counter medicines is needed.     

社区卫生服务机构基本药物合理用药评价的研究

目的：了解并评价社区卫生服务机构基本药物合理使用情况,为基层基本药物合理用药提供参考意见。方法：对社区卫生服务机构进行抽样调查,通过对处方进行抽样和对医生进行抽样问卷调查,根据医疗机构合理用药评价指标对处方基本药物使用情况进行评价,并分析可能导致不合理用药的相关因素。结果：单张处方平均使用药品数为：城区（4．9±1．2）个,农村（213±0．7）个;每100张处方抗生素使用比例：城区78．9％,农村57．3％,其中两联使用比例分别为20．1％和32．4％;人均药费：城区为（36．9±5．2）元,农村为（21．3±4．7）元;参加合理用药培训的医生所开处方药品合理使用的比率是98．0％,而未参加过培训的医生合理用药的比率是77．1％,经卡方检验,差异有统计学意义,P〈0．05。结论：社区卫生服务机构存在一定的基本药物使用不合理现象,对医生加强基本药物合理使用的培训可以提高基本药物合理使用率。     

Medical manpower two years on.

Medical manpower in Britain, with particular reference to the NHS, was analysed for 1976 and 1977. The output of British medical schools increased. The total of doctors in the NHS rose by 2% between 1975 and 1976 and by 2.4% between 1976 and 1977. The highest and lowest growth rates were in junior and senior hospital staff grades respectively, while the highest growth rate in career grades seemed to be in community medicine and health. The inflow of overseas doctors remained high, though few tended to remain permanently in Britain. Continuous evaluation of the medical manpower position is needed before long-term predictions can confidently be made.     

The effect of increased consumer demand on fees for aesthetic surgery: an economic analysis

Economic theory dictates that changes in consumer demand have predictable effects on prices. Demographics represents an important component of demand for aesthetic surgery. Between the years of 1997 and 2010, the U.S. population is projected to increase by 12 percent. The population increase will be skewed such that those groups undergoing the most aesthetic surgery will see the largest increase. Accounting for the age-specific frequencies of aesthetic surgery and the population increase yields an estimate that the overall market for aesthetic surgery will increase by 19 percent. Barring unforeseen changes in general economic conditions or consumer tastes, demand should increase by an analogous amount. An economic demonstration shows the effects of increasing demand for aesthetic surgery on its fees. Between the years of 1992 and 1997, there was an increase in demand for breast augmentation as fears of associated autoimmune disorders subsided. Similarly, there was increased male acceptance of aesthetic surgery. The number of breast augmentations and procedures to treat male pattern baldness, plastic surgeons, and fees for the procedures were tracked. During the study period, the supply of surgeons and consumer demand increased for both of these procedures. Volume of breast augmentation increased by 275 percent, whereas real fees remained stable. Volume of treatment for male pattern baldness increased by 107 percent, and the fees increased by 29 percent. Ordinarily, an increase in supply leads to a decrease in prices. This did not occur during the study period. Economic analysis demonstrates that the increased supply of surgeons performing breast augmentation was offset by increased consumer demand for the procedure. For this reason, fees were not lowered. Similarly, increased demand for treatment of male pattern baldness more than offset the increased supply of surgeons performing it. The result was higher fees. Emphasis should be placed on using these economic relationships to expand the demand for aesthetic surgery.     

Community medicine for clinicians in Canada: a recommendation for postgraduate training.

A large gap presently exists between the predominantly biologic expertise of the medical profession and the complex mixture of biologic, behavioural and epidemiologic components of health problems today. Furthermore, the development of community medicine in Canada has been relatively separate from that of the clinical disciplines. To enable clinicians to acquire the knowledge and skills to manage these health problems, much more community-oriented research, applied behavioural science and clinical epidemiology is needed within the clinical sector of medicine. I have proposed a definition of clinical community medicine and presented a strategy for training clinicians in community medicine skills that calls for administrators of clinical postgraduate programs to develop training in clinical community medicine. Residency programs in community medicine cannot be expected to provide such training given their nonclinical priorities, which focus mainly on the training of public health physicians.     

中国口腔医师资源结构研究

中国口腔医师数量在近半个世纪里有了明显的增长，但是相对于中国口腔卫生市场需要相差甚远。通过口腔医师的内部结构与区域分布结构的研究，找出口腔医师的结构优势和劣势，提出口腔医师数量的稀缺还可以通过合理的结构分布而得到弥补。     

Cell encapsulation using biopolymer gels for regenerative medicine

There has been a consistent increase in the mean life expectancy of the population of the developed world over the past century. Healthy life expectancy, however, has not increased concurrently. As a result we are living a larger proportion of our lives in poor health and there is a growing demand for the replacement of diseased and damaged tissues. While traditionally tissue grafts have functioned well for this purpose, the demand for tissue grafts now exceeds the supply. For this reason, research in regenerative medicine is rapidly expanding to cope with this new demand. There is now a trend towards supplying cells with a material in order to expedite the tissue healing process. Hydrogel encapsulation provides cells with a three dimensional environment similar to that experienced in vivo and therefore may allow the maintenance of normal cellular function in order to produce tissues similar to those found in the body. In this review we discuss biopolymeric gels that have been used for the encapsulation of mammalian cells for tissue engineering applications as well as a brief overview of cell encapsulation for therapeutic protein production. This review focuses on agarose, alginate, collagen, fibrin, hyaluronic acid and gelatin since they are widely used for cell encapsulation. The literature on the regeneration of cartilage, bone, ligament, tendon, skin, blood vessels and neural tissues using these materials has been summarised.     

The interplay between species' positive and negative interactions shapes the community biomass–species richness relationship

We used an individual-based spatially-explicit model to assess the role of facilitation and plant strategies in shaping the 'community biomass–species richness' relationship. Facilitation had few impacts on community's richness under both the most benign (high community biomass) and the most severe (low community biomass) environments where its intensity was weak. From medium to high environmental severity, facilitation increased community richness, because all plant strategies were facilitated. In contrast, from low to medium environmental severity facilitation decreased community richness, because only the most competitive species were facilitated, which induced a decrease in the richness of the stress-tolerant species overwhelming the increase in richness of the competitive species. Above all, our simulations show how 'strategy-dependent' interactions among species combine to shape the humped-back biomass–species richness relationship. It also demonstrates that facilitative effects might have long-term negative effects on species richness, which result is not included in current facilitation models.     

大连金普新区碳固持生态服务供需格局时空差异

碳固持服务供需匹配状况对于优化区域生态系统管理、提升生态系统碳汇能力具有重要意义。以大连金普新区为研究区,利用InVEST模型、ArcGIS模型,研究固碳项生态系统服务供需匹配及其变化特征。结果表明：(1)研究期内,2010年至2018年,碳固持服务供给总量呈现出U字型变化趋势;需求总量呈现出持续增长的变化趋势,表现为低等级需求量地区向高等级需求量地区不断转化;碳固持服务供需求不匹配,供需错配现象突出,总体上呈现出供不应求。(2)碳固持服务供需赤字缺口正持续扩大。赤字类型总面积有持续增加的趋势;盈余类型总面积表现为先增后减;供需相对平衡类型总面积不断缩减,朝着低供给高需求方向转变。(3)金普新区碳汇地面积持续缩减,2018年仅为564km²;碳源地面积大量增加,2018年达到1340km²。(4)提出了控制城镇碳需求增长,增加绿地,提高碳供给能力,消减赤字,维持供需能力基本平衡的对策。     

Effect of Community Engagement Interventions on Patient Safety and Risk Reduction Efforts in Primary Health Facilities: Evidence from Ghana

Background

Patient safety and quality care remain major challenges to Ghana’s healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE) in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed.

Purpose

This paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities.

Methods

A randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities.

Findings

Clinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05) and staff competencies (Coef. = 7.1, p<0.05). Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the baseline and follow-up period. Community groups that were gender balanced, religious/faith-based, and had structured leadership appeared to be better options for effective SCE in healthcare quality assessment.

Conclusion

Community engagement in healthcare quality assessment is a feasible client-centered quality improvement option that should be discussed for possible scale-up in Ghana and other resource poor countries in Africa.     

Lathyrus sativus (grass pea) and its neurotoxin ODAP

Lathyrus sativus (grass pea) is a high-yielding, drought-resistant legume consumed as a food in Northern India and neighboring countries as well as in Ethiopia. Its development into an important food legume, however, has been hindered by the presence of the neurotoxin - beta-N-oxalyl-L-alpha,beta-diaminopropionic acid (beta-ODAP) in seeds which, if consumed in large quantities for prolonged periods, can cause irreversible paralysis. Recently, some low-toxin lines have been developed that may prove safe for both animal and human foods. Cultivation of L. sativus should thus be considered in suitable regions because the demand for legume animal feed protein products is expected to increase. This paper addresses advances in understanding L. sativus from the perspective of its taxonomy, genetics, ecology, chemistry, nutrition, medicine, biology and for animal nutrition.     

The role of school medicine doctors in health education in Croatia--past, present and future

Croatia never had a separate vocation (occupation) of a health educator. Health education is one of the main tasks in the long tradition of preventive work of doctors-school medicine specialists. Additionally, in the school curriculum in the Republic of Croatia the health-educational contents are integrated into various subjects, and are conducted by teachers. However, there are requests to introduce a new subject into schools called Health Education. We asked physicians of school medicine their opinion on the introduction of this new subject. 30% of the physicians were dissatisfied with the current condition, 10% were satisfied, while there were no very satisfied school medicine doctors. They believe that health education goals are oriented solely to passing on knowledge (facts), while efforts are not done to change habits and attitudes of young people. They recognize themselves as persons mostly involved in health education in schools. Half of the school medicine doctors believe that the school curriculum should contain both a separate subject as well as integration of health education into other subjects. Before introducing any changes into healthcare or education system, it is necessary to examine the attitudes of students and parents, to direct the changes towards the promotion of the cooperation between the healthcare system, education, civil society, school and community where investing into the health of young people is done through comprehensive and holistic programmes.