Bovine spongiform encephalopathy in Switzerland--the past and the present

The first case of bovine spongiform encephalopathy (BSE) in Switzerland was diagnosed in November 1990, although the risk factors identified in the United Kingdom were not all present in Switzerland. At 29 December 1998, a total of 282 BSE cases (all animals born in Switzerland), had been recorded. The number of cases is declining, with fourteen cases diagnosed in 1998 (at 29 December 1998). The measures taken are effective. However, the potential weakness in current activities that allow the disease to exist are being evaluated. Further measures to avoid even minimal risk for human and animal health will be taken if required. Experience gained from the past indicates that it is necessary to review the situation constantly and to inform the public and professionals regularly and in a transparent manner.     

Breast-milk substitutes: past and present

The historical development of industrialized products used as breast-milk, substitutes a process begun in the 18th century, is studied. The marketing strategy currently adopted infant formula companies is stressed and the different commercial practices used in the search for new markets in third world countries are described. A warning is given as to the precise instructions giver for the use of the so-called breast-milk substitutes, and the attention of health professionals and consumer groups is called to the low level of awareness regarding this subject, a factor which led the World Health Organization and United Nations Children's Fund to recommend the preparation of an appropriate marketing code and to its adoption by Brazil.     

Mortality of the population in Slovakia: past and present

This contribution presents an analysis of the health status of the Slovakian population using trends in overall mortality, death rates from major diseases, and of other health indicators. The health status of the Slovak population at the beginning of this century as well as at the time of the establishment of Czechoslovakia in 1918 was very bad. This situation is demonstrated by the extremely high infant mortality rate, short life expectancy and enormous mortality from infectious diseases, particularly from tuberculosis. Despite progress before the Second World War, only in the postwar period was the health status comparable with other developed countries of western Europe as there was a rapid improvement of health lasting until the middle of 1960s. This positive evolution resulted mainly from the extensive use of preventive measures against infectious diseases, contributing to the decline of infant mortality and the gradual prolongation of life expectancy. A simultaneous rapid increase of noninfectious, mainly chronic diseases, particularly of cardiovascular diseases and cancer was observed. Attempts to deal with this increase lead only to enlargement of treatment facilities. The whole health policy in prevention, including the pre- and postgradual education of physicians and paramedical personnel, remained in its traditional orientation against infectious diseases. This situation, together with low social and moral standard of the population, increasing consumption of cigarettes, alcohol and inadequate composition and superfluous food led to the rapid deterioration of the health status of the Slovakian population in the past three decades. The orientation of the health policy to the prevention of noninfectious, mainly chronic, degenerative diseases and, above all a change of the attitude of the inhabitants of this country to their own health, present the only way to the substantial and rapid improvement of the health status of the population of Slovakia.     

Family planning in Hungary: past and present

Periconceptional Care Service begins 3 month before the planned pregnancy and continues until 12th week of pregnancy. Its goal is to prevent congenital abnormalities (CAs) and preterm birth. Nowadays, 20-25% of infant mortality is caused by CAs in industrialized countries and CAs are among the leading causes of death. An important feature of CAs is that they represent a defect condition; therefore it's difficult to achieve a complete recovery. Thus, prevention is considered the only optimal solution in the medical care of cases affected with CA. In the last 25 years, several studies confirmed the possible prevention of CAs mainly neural-tube defects (NTDs) by folic acid supplementation during periconceptional period. Family Planning Service exists in Hungary since 1984. This model is optimal for the introduction of periconceptional folic acid/multivitamin supplementation, thus provide an effective method for primary prevention of birth defects.     

Personalizing medicine: Futures present and past

Since the 1990s, 'personalized medicine' has become a powerful language in which to imagine significant change in medicine from a 'one size fits all' model to one that tailors prediction, diagnosis and treatment to the individual. Two decades on, personalized medicine remains a contested vision of the future. Drawing on work in the sociology of expectations, I argue that expectations about genomics to bring about a personalized medicine are 'prefigured' by other ways in which knowledge about individual specificity and variability have been at the centre of claims and counterclaims about the future of medicine since the 19th century. Examining how and why medical universalism or a 'one size fits all' model of medicine has been contested over time, I conclude by considering the limits of what genomics has to offer for personalizing medicine.     

The past and present of peritoneal dialysis

The author reviews briefly the history of peritoneal dialysis, and highlights the significance of the work of two Hungarian nephrologists, Stephen I. Vas and István Taraba . By now, peritoneal dialysis has been considered as equal renal replacement modality compared to haemodialysis. It is even more advantageous in the protection of the patients' residual renal function, morbidity-mortality indices, and quality of life peritoneal dialysis in the first two years. From economical point of view peritoneal dialysis is less expensive than hemodialysis, therefore in the future its greater role can be expected in the treatment of more and more renal patients. The recently achieved technical development, and also the more widespread use of the automated peritoneal dialysis machines contribute to quality improvement. The peritoneal dialysis therapy, by the patients' self-treatment, establishes a new kind of relationship between the patients and the medical personnel; there is a growing requirement for patient education, the patients' self-esteem and cooperation increase, which altogether provides better results in rehabilitation and higher quality of life. Our national peritoneal dialysis utilization falls behind the European achievements, but has been growing dynamically, and we can expect an increase of the number of renal patients on peritoneal dialysis.     

Medicare: past, present and future

The history of the Medicare program, including changes that have been enacted over the years in an effort to control spiraling costs, is reviewed. Medigap insurance and preventive medical care for the elderly are examined, as is the impact of Medicare coverage for the terminally ill. Trends indicate that the Medicare system as presently structured is not financially viable. The question is: what will replace it?