Human babesiosis, an emerging zoonosis

Data of human babesiosis are shortly reviewed with particular emphasis to Europe. In Europe, most cases of human babesiosis are caused by Babesia divergens. Although both phenotypic and genotypic features suggest that zoonotic B. microti may occur in Europe, convincing medical evidence is lacking. Recently a non-Babesia divergens organism causing zoonotic infection has been found in Italy and Austria. Overall, the seroprevalence against both B. microti and B. divergens microrganisms in human ranges 1.5%-11.5% in Europe.     

Why change habits? Early modern medical innovation between medicalisation and medical culture

Based on a discussion of the concept of medicalisation and medical culture in Anglo-American, French-, and German-speaking historiography the paper argues that medical innovation in Europe from the sixteenth to the mid-nineteenth century should be approached in a different way. Instead of asking from the perspective of a too narrow concept of medicalisation why medical innovations were rejected by the population, (medical) historians should analyse medical culture and ask why people should have changed their health and illness behaviour. This conceptual argument is deduced from four empirical examples: the introduction of smallpox vaccination, "medical police," the problem of medical professionalization, and the questions arising around the relations between the healthy/sick and their practitioners.     

德国医院临床运行模式浅析及其启示

德国奥格斯堡中心医院是一所综合性公立性医院,患者就诊能享受几乎全免费医疗服务,其眼科的运行方式,能够代表德国医疗体系的特点。医务人员具有高度的责任感,主动营造良好的医患沟通氛围。临床诊治严格遵循欧洲最新的眼科诊疗指南,询证医学证据。

     

分子影像:转化医学的重要工具和主要路径

随着基础医学与临床医学脱节现象的日益凸显,作为二者之间连接纽带和桥梁的转化医学越来越受到重视.近年来,转化医学在美、欧等西方国家迅速发展,在我国也正成为"十二五"期间医学领域的重要发展方向之一.分子影像作为现代分子生物学与先进医学影像技术相结合的产物,可以利用影像方法对活体内分子的生物化学过程进行定性和定量研究,是将基...     

Pédiatrie nucléaire en Europe

The differentiation of paediatric from adult nuclear medicine has developed in Europe over the past thirty years. It coincides with the birth and the growth of the European association of nuclear medicine and its journal. Through Pubmed, it is possible to measure the friendly and constructive competition between North America and Europe, both in search of medical universality. Mankind owes to the child the best it has to give, told the preamble of the Declaration of the Rights of the Child. European paediatric nuclear medicine contributes to this challenge.     

Medical devices manufactured from latex: European regulatory initiatives

In Europe the marketing of medical devices manufactured from latex is regulated by directives describing the essential (safety) requirements that products have to fulfill to obtain marketing approval. This paper describes the general requirements for marketing medical devices in Europe and, more specifically, the requirements for products manufactured from natural rubber latex. The requirements for marketing medical devices can be fulfilled by using the relevant harmonized European standards. These standards are regularly under revision to incorporate the latest scientific developments. For certain devices, for example, latex medical (examination and surgical) gloves, specific standards have been published. Medical devices manufactured from latex pose a serious problem because of the risk of induction of allergy both against the latex proteins inherently present (type I or immediate type allergy) and against chemicals added during processing (type IV or delayed type hypersensitivity) present as residues in the latex products. So, besides requirements for product quality in terms of barrier properties, strength, and sterility, the main focus consists of the allergy-inducing properties of the latex products. Recent developments have reopened the discussion on the value of total protein versus allergen determination in latex medical gloves. However, as long as minimal levels needed for both sensitization and elicitation have not been established, a safe maximum level for leachable proteins/allergens in latex products cannot be determined. A European Commission guidance document on the latex allergy problem is currently being drafted by experts from Competent Authorities.     

East-West mortality divide and its potential explanations: proposed research agenda.

There is a sharp divide in mortality between eastern and western Europe, which has largely developed over the past three decades and is caused mainly by chronic diseases in adulthood. The difference in life expectancy at birth between the best and worst European countries in this respect is more than 10 years for both sexes. The reasons for these differences in mortality are not clear and data currently available permit only speculation. The contributions of medical care and pollution are likely to be modest; health behaviour, diet, and alcohol consumption seem to be more important; smoking seems to have the largest impact. There is also evidence that psychosocial factors are less favourable in eastern Europe. Available data show socioeconomic gradients in all cause mortality within eastern European countries similar to those in the West. Determinants of the mortality gap between eastern and western Europe are probably related to the contrast in their social environments and may be similar to those underlying the social gradients in mortality within countries.     

Green biotechnology and European competitiveness

Europe has led many aspects of gene research and yet it has been unable to translate these discoveries into a globally dominant industrial sector. There are valid societal, political and financial reasons for its reluctance to deploy agricultural biotechnology but this reluctance might have unintended consequences. It will be hard to de-commoditize agriculture and improve farmer's lives. Research in medical biotechnology and the global environment might suffer. Europe could damage its overall economy and its global competitive standing.     

Medical tourism: globalization of the healthcare marketplace

The citizens of many countries have long traveled to the United States and to the developed countries of Europe to seek the expertise and advanced technology available in leading medical centers. In the recent past, a trend known as medical tourism has emerged wherein citizens of highly developed countries choose to bypass care offered in their own communities and travel to less developed areas of the world to receive a wide variety of medical services. Medical tourism is becoming increasingly popular, and it is projected that as many as 750,000 Americans will seek offshore medical care in 2007. This phenomenon is driven by marketplace forces and occurs outside of the view and control of the organized healthcare system. Medical tourism presents important concerns and challenges as well as potential opportunities. This trend will have increasing impact on the healthcare landscape in industrialized and developing countries around the world.     

The Flexner Report--100 years later

The Flexner Report of 1910 transformed the nature and process of medical education in America with a resulting elimination of proprietary schools and the establishment of the biomedical model as the gold standard of medical training. This transformation occurred in the aftermath of the report, which embraced scientific knowledge and its advancement as the defining ethos of a modern physician. Such an orientation had its origins in the enchantment with German medical education that was spurred by the exposure of American educators and physicians at the turn of the century to the university medical schools of Europe. American medicine profited immeasurably from the scientific advances that this system allowed, but the hyper-rational system of German science created an imbalance in the art and science of medicine. A catching-up is under way to realign the professional commitment of the physician with a revision of medical education to achieve that purpose.     

History of disease and the longue durée

This paper summarizes Grmek's theoretical contribution to history of disease and explores to what extent the longue durée could still be a useful concept in order to better understand past perceptions of, and reactions to, diseases. The case of the medical responses to epidemic disease in pre-industrial Europe is synthetically expounded in order to illustrate this issue.     

Cross-cultural issues in European bioethics

European biomedical ethics is often contrasted to American autonomy-based approaches, and both are usually distinguished as 'Western'. But at least three 'different voices' within European bioethics can be identified:
The deontological codes of southern Europe (and Ireland), in which the patient has a positive duty to maximise his or her own health and to follow the doctor's instructions, whilst the physician is constrained more by professional norms than by patient rights
The liberal, rights-based models of Western Europe, in which the patient retains the negative right to override medical opinion, even if his or her mental capacity is in doubt
The social welfarist models of the Nordic countries, which concentrate on positive rights and entitlements to universal healthcare provision and entrust dispute resolution to non-elected administrative officials     

Changes in the geographical distribution of malaria throughout history

Climatic changes must have greatly affected the distribution of malaria in prehistoric times. Paleobotanical evidence, snowline depression studies and information obtained from deep sea sediment cores, indicate that southern Europe must have suffered a drop of summer temperatures of approximately 9 degrees C during the last glacial maximum, 18,000 years ago. Such a drop would have been decisive as regards the distribution of malaria and its vectors. If present at all, the disease would have been confined to the southernmost parts of the continent but P. falciparum and today's most effective vectors--A. labranchiae and A. sacharovi--would have been excluded from Europe. In western Asia, summer temperatures 6 degrees C lower than those of today would have had less effect on the malaria situation. The introduction of falciparum malaria in southern Europe is placed in Hellenistic and Early Imperial Roman times, based on paleoclimatological evidence and historical and medical data. In America P. falciparum is also considered a late entrant but vivax and quartan malaria may have been introduced in pre-Columbian times. In the Pacific, the disease is known to have been spread by man since the Age of Discovery until contemporary times.     

Experience of two teratology information services in Europe

Teratology Information Services (TIS) are started in different countries in Europe in order to gather available data on exogenous agents, to evaluate their pertinence to human subjects, and to apply this knowledge to specific cases. Most European centers can only be consulted by medical professionals. The experience of two such services (Lyon, France, and Bilthoven, The Netherlands) is described. Attention is given to the task of TIS, risk evaluation, operational methods, and functioning and future developments.     

A generic curriculum development model for the biomedical physics component of the educational and training programmes of the non-physics healthcare professions

The objective of the study was the construction of a generic curriculum development model for the use of biomedical physics (BMP) educators teaching the non-physics healthcare professions (HCP) in Europe. A comprehensive, qualitative cross-sectional Europe-wide survey of the curricula delivered by BMP in Faculties of Medicine and Health Sciences (FMHS) was carried out. Curricular content was collected from faculty web-sites, curricular documents and textbooks. The survey data was supplemented with semi-structured interviews and direct observation during onsite visits. The number of faculties studied was 118 from 67 universities spread all over Europe, whilst the number of onsite visits/interviews was 15 (geographically distributed as follows: Eastern Europe 6, North Western Europe 5, and South Western Europe 4). EU legislation, recommendations by European national medical councils, educational benchmark statements by higher education quality assurance agencies, research journals concerning HCP education and other documents relevant to standards in clinical practice and undergraduate education were also analyzed. Best practices and BMP learning outcomes were elicited from the curricular materials, interviews and documentation and these were subsequently used to construct the curriculum development model. A structured, comprehensive BMP learning outcomes inventory was designed in the format required by the European Qualifications Framework (EQF). The structures of the inventory and curriculum development model make them ideally suited for use by BMP involved in European curriculum development initiatives for the HCP.     

Global epidemiology and burden of hepatitis C

Despite rapid progress in our knowledge of hepatitis C virology and pathogenesis, little is known about the current and future burden of this infection throughout the world. Prevalence and population-based studies have suggested that complications of the liver disease associated with chronic hepatitis C infection may potentially require substantial health care resources and generate very high costs for medical systems in the United States, Europe and worldwide. Careful understanding and assessment of hepatitis C health and economic burdens are likely to guide better programs for the management of infected individuals and the prevention of complications.     

Giacomo Andrea Giacomini: a Padua clinician between metaphysics and science

As Professor of Theoretical Medicine for Surgeons at Padua University between 1824 and 1849, Giacomini achieved a position of great academic professionalism and prestige, not only in Padua, but throughout Italy and Europe. His fundamental medical thesis became part of the established field of medical practice that existed into the first decades of the 19th century. This thesis, derived directly from a vitalistic concept of biological phenomena, was based on the existence of a 'life force' that is distinct from the forces of physical-chemistry, having its own specific laws, contrary to those of physical-chemistry. Using this concept Giacomini was able to distinguish two causes of death: mechanical illness and dynamic illness. The nosographic and therapeutic beliefs of Giacomini were based on his distinction between the 'mechanical' or 'dynamic' effects of drugs. Giacomini's medical philosophy is the result of an interweaving of scientific theories and metaphysical ideas. The merits and limits of this philosophy must be analysed in the light of modern epistemology to explain why Giacomini was unable to develop fully clinical anatomy.     

A biometeorology study of climate and heat-related morbidity in Phoenix from 2001 to 2006

Heat waves kill more people in the United States than hurricanes, tornadoes, earthquakes, and floods combined. Recently, international attention focused on the linkages and impacts of human health vulnerability to urban climate when Western Europe experienced over 30,000 excess deaths during the heat waves of the summer of 2003-surpassing the 1995 heat wave in Chicago, Illinois, that killed 739. While Europe dealt with heat waves, in the United States, Phoenix, Arizona, established a new all-time high minimum temperature for the region on July 15, 2003. The low temperature of 35.5 degrees C (96 degrees F) was recorded, breaking the previous all-time high minimum temperature record of 33.8 degrees C (93 degrees F). While an extensive literature on heat-related mortality exists, greater understanding of influences of heat-related morbidity is required due to climate change and rapid urbanization influences. We undertook an analysis of 6 years (2001-2006) of heat-related dispatches through the Phoenix Fire Department regional dispatch center to examine temporal, climatic and other non-spatial influences contributing to high-heat-related medical dispatch events. The findings identified that there were no significant variations in day-of-week dispatch events. The greatest incidence of heat-related medical dispatches occurred between the times of peak solar irradiance and maximum diurnal temperature, and during times of elevated human comfort indices (combined temperature and relative humidity).