Church and society. developments during the Schwitalla years, 1928-1947

As CHA evolved and expanded in the 1930s, it became a more complex organization with wider responsibilities--and more intractable problems--than it had had before. The third article in the six-part Health Progress series on the history of CHA (April 1990) described the struggles of Rev. Alphonse M. Schwitalla, SJ, the association's second president, to develop effective CHA programs and policies on nursing education. CHA's relations with other national Catholic organizations, the growth and eventual autonomy of its Canadian member hospitals, and its role as an advocate of federal healthcare legislation during the Depression and World War II are covered in this article. Next month's installment will describe CHA's modernization and expansion under the leadership of Rev. John J. Flanagan, SJ.     

Years of transition. Internal developments under Fr. Schwitalla, 1928-1947

Dedicated to helping Catholic hospitals keep pace with rapid changes in the healthcare field, CHA flourished under the leadership of its first president, Rev. Charles B. Moulinier, SJ, who served from 1915 to 1928. The second in a series of Health Progress articles on the Catholic Health Association's history (March 1990) recounted Fr. Moulinier's efforts to expand CHA's role as a national organization serving Catholic hospitals. This article describes the work of Rev. Alphonse M. Schwitalla, SJ, to reorganize CHA and to develop a program for evaluating Catholic schools of nursing. In May, a fourth article will focus on CHA's developing relationships with other national Catholic organizations and its expanded role as an advocate of healthcare policy reform.     

The modern association. Preserving a Catholic presence in the U. S. healthcare system

A leader in U. S. Catholic healthcare since 1915, CHA has helped Catholic hospitals meet the challenges of the standardization movement, the Depression, and two world wars. The fifth Health Progress article on CHA's history (June 1990) described the association's postwar emergence as a service organization under the leadership of Rev. John J. Flanagan, SJ. This article, the last in the series, charts CHA's response to the revolutionary changes within Catholic healthcare brought about by the Second Vatican Council and the passage of Medicare. It recounts the struggles within the U.S. Catholic healthcare community to sustain its Catholic identity, as well as the community's increased presence as an advocate for a just healthcare system. In the spirit of the institutes of women religious who established the Catholic healthcare ministry in the United States, CHA enters the 1990s committed to advocating for universal access to healthcare and enhancing its members' ability to serve the poor and vulnerable.     

Community health assessment: driving the need for current, easily accessible population health data.

Community health assessment (CHA) is a core public health function. Community health assessment is a term that describes both a process and its tangible products, such as a community health profile or other types of reports on the status of the community's health and existing influences on its health, including the extent and nature of health-related resources. Assessment has enabled a better understanding of the community's health, and this has impacted public health decisions. The authors use the framework for community health improvement proposed in 1997 by the Institutes of Medicine to show how CHA is part of the community health improvement process. Community health assessment drives the need for current, easily accessible population health data. The importance of Web-based data query systems, the focus of the other articles in this special issue, can be best understood within the broader context of CHA. Selected case examples of how Web-based data query systems have impacted the CHA process in three states are highlighted.     

How to approach Catholic identity in changing times. Catholic Health Association of the United States

The Catholic healthcare ministry is at a challenging moment in its history. Not only is the ministry called to continue to be authentic to its own self, but the ministry also has the opportunity to communicate the richness and universality of its values to others. In response to our members' genuine concerns, the Catholic Health Association of the United States (CHA) has prepared this document to support our members in the expression of their Catholic identity in new forms of healthcare service.     

CHA 2000 recommendations: a guide to the future. Catholic Health Association

The following is an excerpt of the CHA 2000 Task Force Final Report and Recommendations, approved by the Catholic Health Association (CHA) Board of Trustees at its April meeting. The recommendations for the future of CHA were presented to the CHA membership at the annual business meeting at the Joint Assembly of the Catholic Health Associations of Canada and the United States, June 10 in Montreal.     

心房颤动患者预后评分系统的构建和比较

目的构建心房颤动人群预后预测工具,并对其预测能力进行比较评估。方法连续性纳入275例新发心房颤动患者,随访终点包括卒中和全因死亡。收集相关基线资料,检测患者基线血浆N末端B型利钠肽原(N-terminal pro B-type natriuretic peptide,NT-proBNP)、高敏肌钙蛋白T(high-sensitivity cardiac troponin T,hs-cTnT)、生长分化因子15(growth differentiation factor-15,GDF-15)浓度。运用Cox比例风险模型构建卒中和死亡风险评分系统。应用C-统计量和校准图比较评分系统的预测能力。结果多因素Cox回归显示,糖尿病、短暂性脑缺血发作(transient ischemic attack,TIA)、卒中史、血浆NT-proBNP浓度与心房颤动患者卒中风险独立相关;年龄、心衰史、血浆hs-cTnT和GDF-15浓度与心房颤动患者全因死亡风险独立相关。我们构建的卒中风险评分系统预测能力与国外年龄、生物标志物和临床病史(age,biomarker,clinical history,ABC)卒中评分以及CHA2DS2-VASc评分相当,死亡风险评分系统与国外ABC死亡评分相当,优于CHA2DS2-VASc评分。结论本研究构建的心房颤动患者卒中和死亡风险预测评分系统表现出较好的预测性能,此评分系统的列线图可望作为临床决策的辅助工具。     

Accessibility and the Canadian health care system: squaring perceptions and realities

The 1984 Canada Health Act (CHA) is the major piece of Federal legislation that governs health care accessibility in the provinces and territories. According to the CHA, all provinces and territories in Canada must uphold five principles in order to receive federal funding for health care (universality, comprehensiveness, portability, public administration, and accessibility). In Canada, there are competing views among policy makers and consumers about how the CHA's principle of accessibility should be defined, interpreted and used in delivering health care. During the 1990s, the health care perceptions of Canadians and their health care behaviours were measured through both public opinion polls and Statistics Canada's National Population Health Survey (NPHS). The goal of this paper is to examine perceptions of accessibility in public opinion polls and actual accessibility as measured through the NPHS. Public opinion polls demonstrate that while Canadians want to preserve the principles of the CHA, a majority of Canadians are losing confidence in their health care system. In contrast, the results from the NPHS reveal that only 6% of Canadians aged 25 years and older have experienced accessibility problems. Among those who report access problems, the barriers to accessibility are linked to specific socio-economic, socio-demographic and health characteristics of individuals. We discuss these findings in the context of the current debates surrounding accessibility within the CHA and the Canadian health care system.     

Using Community-Driven,Participatory Qualitative Inquiry to Discern Nuanced Community Health Needs and Assets of Chicago’s La Villita,a Mexican Immigrant Neighborhood

In predominately immigrant neighborhoods, the nuances of immigrant life in the ethnic enclave have important, yet underappreciated impact on community health. The complexities of immigrant experiences are essential to unpacking and addressing the impact of acculturative processes on observed racial, ethnic, and class-based health disparities in the United States. These insights because they are largely unexplored are best captured qualitatively through academic-community research partnership. We established the participatory mixed method Little Village participatory community health assessment (CHA) to explore community health in an ethnic enclave. In this paper, we share findings from our qualitative component exploring: how do Residents in a Predominately Immigrant Neighborhood Perceive Community Health Needs and Assets in Little Village. Three major themes emerged: rich, health promoting community assets inherent in the ethnic enclave; cumulative chronic stress impacting the mental health of families and intra-familial strain; and, work and occupation as important but underappreciated community health determinants in an immigrant neighborhood. These nuanced findings enhanced our community health assessment and contributed to the development of two additional tailored CHA methods, a community member-administered Community Health Survey, and an oral history component that provided deeper insight on the community’s health needs and assets, and a focus for action on work as a social determinant of health at the community level. Conducting trusted community-driven health assessments that are adaptive and flexible to capture authentic needs and assets are critical, given health consequences of the new anti-immigrant rhetoric and growing socio-political tensions and fear in immigrant neighborhoods in the United States.     

组织工程骨结合血管束植入用于下颌骨缺损重建的实验研究

目的构建组织工程骨,并植入血管束促进其血管化,探讨其在实验性下颌骨缺损修复中的效果。方法将6只实验用犬随机分为2组,在双侧下颌骨体部制备30mm×15mm缺损,右侧骨缺损为实验侧,左侧为空白对照侧。体外分离培养犬骨髓基质干细胞(bone marrow mesenchym al stem cells,BMSCs)后与珊瑚羟基磷灰石(coral hydroxylapatite,CHA)复合培养,A组实验侧植入自体BMSCs和CHA,B组实验侧在植入BMSCs和CHA的同时植入颈部血管束。术后4、8、12周时分别观察X线影像学表现及评分,评价成骨效果。结果 2组实验侧的骨缺损区均有CHA的吸收和新生骨形成,X线片评分随时间延长逐渐升高。空白对照侧缺损区均未见新骨形成。B组在X线评分方面优于A组(p<0.05)。结论采用自体BMSCs和CHA构建的血管化复合组织工程骨能够有效修复实验性下颌骨缺损,而血管束植入能够促进组织工程骨血管化过程。     

老年心房纤颤患者不同抗栓治疗方案的临床观察

目的观察老年心房纤颤(房颤)患者使用口服抗凝药进行抗栓治疗的临床效果。方法选择2010—2011年年龄大于75岁持续性房颤患者232例。依据CHA2DS2系统评分大于2分栓塞风险较高,建议口服抗凝药抗栓治疗,HAS-BLED评分系统大于3分相对出血风险较高,需综合评估风险与收益选择治疗方案。根据不同的抗栓治疗方案将所有病例(232例)随机分为华法林组(95例)、阿司匹林组(103例)与氯吡格雷组(39例)。记录所有患者基本临床资料(性别、年龄、高血压病史、糖尿病史、卒中史、冠心病史等),观察各组间基本资料分布情况和口服药物6个月内定期随访患者不良事件的发生情况。结果在华法林组有高血压59例(62.1%),阿司匹林组75例(72.8%),高于氯吡格雷组7例(20.6%),经比较,差异有统计学意义(P0.01);其他基本临床资料3组间差异无统计学意义。华法林组CHAD2S2-VASc评分明显高于阿司匹林组和氯吡格雷组,差异有统计学意义(4.2±1.1 vs 3.9±0.9,3.6±0.7,P0.05);栓塞发生率氯吡格雷组4例(11.8)、阿司匹林组9例(8.7),与华法林组1例(1.1%)比较,差异有统计学意义(P0.05)。3组间HAS-BLE评分、轻微出血、大出血比较,差异无统计学意义。3组均无死亡病例。结论对于栓塞及出血风险均相对较高的老年房颤患者,使用口服抗凝药将国际标准化比值(INR)控制在2.0～3.0之间可明显降低栓塞发生率,并未明显增加出血风险。     

A voice against physician-assisted suicide

In the early hours of November 14, 1996, Card. Joseph Bernardin died of pancreatic cancer. The Archbishop of Chicago approached death not in fear but as a "transition from earthly life to life eternal." One of his last public acts was writing a letter to the U.S. Supreme Court. He asked the justices to reject arguments that the dying have a right to physician-assisted suicide. In two powerful and poignant pages, the cardinal concisely summarizes the legal and policy arguments against legitimizing the purposeful facilitation of death by healthcare providers. CHA attached his letter to the amicus curiae brief it filed with the U.S. Supreme Court in Vacco v. Quill and Washington v. Glucksberg, the two physician-assisted suicide cases to be decided by the Court this term (see "CHA Amicus Curiae Brief on Physician-Assisted Suicide," p. 36). In this article we provide context for the thoughts expressed in Card. Bernardin's letter, excerpted below, and describe how this letter makes a persuasive legal argument against physician-assisted suicide.     

Cross-protective efficacy of engineering serotype A foot-and-mouth disease virus vaccine against the two pandemic strains in swine

Foot-and-mouth disease (FMD) is a highly contagious vesicular disease that affects domestic and wild cloven-hoofed animals worldwide. Recently, a series of outbreaks of type A FMDV occurred in Southeast Asian countries, China, the Russia Federation, Mongolia, Kazakhstan and South Korea. The FMD virus (A/GDMM/CHA/2013) from China's Guangdong province (2013) is representative of those responsible for the latest epidemic, and has low amino acid identity (93.9%) in VP1 protein with the epidemic strain A/WH/CHA/09 from Wuhan, China in 2009. Both of isolates belong to the Sea-97 genotype of ASIA topotype. Therefore, the application of a new vaccine strain with cross-protective efficacy is of fundamental importance to control the spread of the two described pandemic strains. A chimeric strain rA/P1-FMDV constructed by our lab previously through replacing the P1 gene in the vaccine strain O/CHA/99 with that from the epidemic stain A/WH/CHA/09, has been demonstrated to exhibit good growth characteristics in culture, and the rA/P1-FMDV inactivated vaccine can provide protection against epidemic strain A/WH/CHA/09 in cattle. However, it is still unclear whether the vaccine produces efficient protection against the new pandemic strain (A/GDMM/CHA/2013). Here, vaccine matching and pig 50% protective dose (PD₅₀) tests were performed to assess the vaccine potency. The vaccine matching test showed cross-reactivity of sera from full dose vaccine vaccinated pigs with A/WH/CHA/09 and A/GDMM/CHA/2013 isolates, with average r₁ values of 0.94 ± 0.12 and 0.68 ± 0.06 (r₁ ≥ 0.3), which indicates that the rA/P1-FMDV vaccine is likely to confer good cross-protection against the two isolates. When challenged with two pandemic isolates A/WH/CHA/09 and A/GDMM/CHA/2013 strain, the vaccine achieved 12.51 PD₅₀ and 10.05 PD₅₀ per dose (2.8 μg), respectively. The results indicated that the rA/P1-FMDV inactivated vaccine could protect pigs against both A/WH/CHA/09 and A/GDMM/CHA/2013 pandemic isolates.     

Charitable intentions. CHA, VHA unveil community-benefit guidelines developed to help not-for-profit hospitals justify their tax exemptions

With new guidelines from the CHA and VHA on reporting community benefits, not-for-profit hospitals are being advised to drop bad debt and Medicare shortfalls from their accounting of how they fulfill their mission. While the AHA doesn't agree, some experts do. MedPAC member Nancy Kane, right, says bad debt "is a tough one, but I don't think a lot of bad debt is a community benefit.     

The asbestos dilemma: II. The ban

This article reviews the history of legal steps which led to conflicting regulatory approaches to the use of asbestos between the EU, the US and the rest of the world. Particular attention is paid to the EU ruling out the use of all types of asbestos. The author criticizes how the Scientific Committee on Toxicity, Ecotoxicity and the Environment of the European Commission altered their own opinion within as short a time as seven months, and points out the weaknesses of the scientific justification for the EU ban. With equal criticism the author addresses the weak scientific rationale on which Collegium Ramazzini founds its call for an immediate and total international ban of the mining and use of all types of asbestos.     

Identification of Brucella melitensis Rev.1 vaccine-strain genetic markers: Towards understanding the molecular mechanism behind virulence attenuation

Brucella melitensis Rev.1 is an avirulent strain that is widely used as a live vaccine to control brucellosis in small ruminants. Although an assembled draft version of Rev.1 genome has been available since 2009, this genome has not been investigated to characterize this important vaccine. In the present work, we used the draft genome of Rev.1 to perform a thorough genomic comparison and sequence analysis to identify and characterize the panel of its unique genetic markers.The draft genome of Rev.1 was compared with genome sequences of 36 different Brucella melitensis strains from the Brucella project of the Broad Institute of MIT and Harvard. The comparative analyses revealed 32 genetic alterations (30 SNPs, 1 single-bp insertion and 1 single-bp deletion) that are exclusively present in the Rev.1 genome. In silico analyses showed that 9 out of the 17 non-synonymous mutations are deleterious. Three ABC transporters are among the disrupted genes that can be linked to virulence attenuation. Out of the 32 mutations, 11 Rev.1 specific markers were selected to test their potential to discriminate Rev.1 using a bi-directional allele-specific PCR assay. Six markers were able to distinguish between Rev.1 and a set of control strains.We succeeded in identifying a panel of 32 genome-specific markers of the B. melitensis Rev.1 vaccine strain. Extensive in silico analysis showed that a considerable number of these mutations could severely affect the function of the associated genes. In addition, some of the discovered markers were able to discriminate Rev.1 strain from a group of control strains using practical PCR tests that can be applied in resource-limited settings.     

有机酸对人血管内皮细胞保护作用的机制研究

目的: 研究氯原酸(CHA)、抗坏血酸(AA)、柠檬酸(CA)和苹果酸(MA)四种有机酸(OA)对单核细胞趋化蛋白1(MCP-1)和单核细胞聚集刺激因子(M-CSF)的影响及其抗氧化作用,探讨有机酸保护人血管内皮细胞的作用机制。 方法: 在体外原代培养人脐静脉内皮细胞(EC)中,分别加入不同剂量(10,20,40 mg/L)的CHA、AA、CA和MA,以及氧化型低密度脂蛋白(ox-LDL,100 mg/L),观察四种OA对ox-LDL引起人血管EC损伤的保护作用。另观察单纯CHA和AA(40 mg/L)对EC的直接作用。 结果: (1)ox-LDL组的TBARS值明显升高,是正常LDL组的14.85倍;加OA各组TBARS值有不同程度的降低,并呈明显的剂量效应关系,其中CHA和AA作用较强,CA和MA作用较弱。(2)ox-LDL组MCP-1和M-CSF较LDL组显著升高;加OA组(40 mg/L)MCP-1和M-CSF分别显著低于ox-LDL组;单纯CHA和AA组分别低于空白对照组。 结论: OA对EC的保护作用与其抗氧化作用有关,而且可能与对EC分泌MCP-1和M-CSF的影响有关。     

Spatial and multidimensional visualization of Indonesia's village health statistics

Background  

A community health assessment (CHA) is used to identify and address health issues in a given population. Effective CHA requires timely and comprehensive information from a wide variety of sources, such as: socio-economic data, disease surveillance, healthcare utilization, environmental data, and health resource allocation.     

The Medical Theory of Richard Koch II: Natural Philosophy and History

Richard Koch¹ became known in the 1920s with works on basic medical theory. Among these publications, the character of medical action and its status within the theory of science was presented as the most important theme. While science is inherently driven by the pursuit of knowledge for its own sake, medicine pursues the practical purpose of helping the sick. Therefore, medicine must be seen as an active relationship between a helping and a suffering person. While elucidating this relationship, Koch discusses the fundamental elements of medicine found in natural philosophy and the relationship of medicine to its own history. One of his aims is to unite natural history and the history of ideas without reducing intellectual processes to biological ones. Koch considers free will as something intuitively certain. It must serve as an axiom which will capture human as well as non-human reality. Based on the fact that human free will, considered a psychic quality, evolved out of inanimate matter, Koch grants matter (proto-) psychic qualities. They are evoked through specific constellations of matter. – With regard to history, Koch rejects the notion of constant progress. The history of medicine has provided insights that cannot be surpassed but can be obscured. Historical self-contemplation serves as a means for avoiding any deviations which may prevent medicine from fulfiling its ultimate purpose. Koch connects nature and history through the concept of a unity between natural history and the historical development of medicine. Medicine is considered an especially complex development of a purposive reaction to harmful stimuli, a reaction which can already be encountered in unicellular organisms. Without intending to reduce historical and mental processes to biological ones, Koch sets for himself the aim of gathering different phenomena and presenting them in one encapsulating unity.     

Moral architecture: the influence of the York Retreat on asylum design

Institutional and architectural history places the asylum alongside the prison and other institutional types whose architectural characteristics emphasized confinement and control. This history obfuscates important differences in how ideas about treatment were represented in the particular design of these institutions; in other words, how the structure of a place became part of its discourse. What becomes obvious in nineteenth-century, asylum architecture is the influence of a small Yorkshire private asylum built by a Quaker, William Tuke, in 1796. The York Retreat, in form, solidified the ideas of 'moral treatment' in design and in turn assumed an exalted character in the design of late nineteenth-century asylums. Every researcher working in the field of the history of insanity acknowledges the importance of this event and its impact on the discourse of insanity for the century to follow. Few however talk about how its unique design was incorporated as part of this discourse.