Public-Health-Ethik

The international discourse about public health ethics is becoming more intensive and complex. The starting point is bioethics. The debate about public health ethics is simultaneously a debate about an adequate identity of public health, its goals, tasks and standards. In Germany there is a tremendous need to take part in this discourse. German experiences within the traditions of social medicine, social hygiene and medical ethics could significantly contribute to the international discussion. Unfortunately the German speaking public health community has hardly acknowledged the topic of ethics. The reasons for this are not explicitly known. The Anglo-American discourse is much more developed, but the concepts, terms and paradigms should not simply be transferred. They should critically be proven.     

Der Dissens in der Public-Health-Ethik

Public health covers public activities linked with cure, prevention and health promotion directed to positively influence the health of populations. As far as these criteria are met, health policies are public health. Public health holds many ethical implications. Resources and health opportunities are redistributed, ends and means of public health as well as rights and duties have to be discussed, and conflicts exist between targets. Ethical policy counselling is an important complement to natural and social scientific policy counselling. However, ethical counselling cannot solve conflicts about values and norms nor does it claim to do so. There are different theories and approaches, recommended principles differ and are in conflict with each other. It must not be expected that a generally accepted frame for public health ethical policy counselling will be developed. Public health ethics can develop an ordering effect and enforce more clarity for actors about their values and norms, but in case of unresolvable dissent between experts it can also be misused to give support to the legitimation of political decisions. Orientation of consulting activities towards the “pragmatistic model” (Habermas) and a counselling of the civil society is promising to prevent such exploitation.     

Public-Health-Ethik ist Partnerschaftsethik

Securing and safeguarding the health of citizens are preeminent governmental obligations and cultural as well as ethical responsibilities. Public health needs to be developed, implemented and reviewed in partnership with existing private and public market forces and with health-literate citizens; mission, strategy, tactics and ethics of public health depend on partnership ethics. Traditional sets of principles in bioethics, research ethics, or clinical ethics are not useful to delineate the framework, the mandate, and the specific conflicts and risks in public health. The SEMPER model exemplifies the role of the principles of safety, education, minimax, partnership, efficiency, review and their interactions for public health in securing and promoting health and quality of life.     

Public-Health-Ethik als Bereichsethik

Public health engagement is strongly connected to a relatively new concept of health promotion. This concept focuses on a general health-related attitude which is to be established through the networking of multiple institutional and private actors. Hence the practical realization of this concept leads to extensive transitions concerning the institutions and health-related interventions involved. Meanwhile a critical view of these transitions has become a public issue. Within the critical discussion, the normative limits of public health are questioned and even the legitimacy of public health proves to be at stake. Public health ethics is therefore called to investigate and explicate the legitimacy and the normative limits of public health engagement. It is advised to do so in an applied ethical, i.e. ethical-political, discourse. The value system of free democratic societies serves as the ethical framework that public health ethics has to refer to. Public health ethics is thus to be regarded as an applied ethical discourse distinct from biomedical ethics.     

Gesundheitsschutz als normatives Kriterium der Medizinethik

Illness and health are terms open to interpretation. Their meaning depends on cultural backgrounds, societal designations and historical change. During the modern era, having been shaped by natural sciences, knowledge in medicine has grown exponentially. However, critical voices warn of a medicalization of the image of humanity or an "absolutization" of health. They emphasize that limits must be set to medical progress. In return it has to be highlighted that contemporary medicine has opened up new chances of therapy, prevention and palliative treatment (pain relief), which could not be applied previously. As a result, it is the responsibility of medicine to make available the highest possible measure of progress to patients. The medical profession is confronted with the task of supporting patients in their right to self-determination and their decision competence. For the individual human being, health is a fundamental good. Therefore, each human individual has the right to health protection and medical care which correspond to the latest medical knowledge available. By now, this right has been acknowledged by human rights conventions and numerous legal documents. From an ethical point of view, health protection has to be interpreted as 1) the right to defense, 2) the right to claim and 3) the patient's right to participate. It falls to medical ethics to substantiate the meaning of health protection for the different spheres of medical activity.     

Abgrenzung und Klassifizierung von Medical Apps

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Smartphones und Tablets mit einer nahezu unbegrenzten Anzahl unterschiedlichster Applikationen sind in unserem alltäglichen...     

Daten zur Palliativversorgung in Deutschland

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Palliativversorgung steht zunehmend im Blickfeld von Politik und Öffentlichkeit. Dabei wird deutlich, dass der Bedarf an...     

Daten zur Antibiotikaresistenzlage in Deutschland

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Im Jahr 2007 wurde am Robert Koch-Institut (RKI) die Infrastruktur von ARS – „Antibiotika-Resistenz-Surveillance in...     

Daten zur Antibiotikaresistenzlage in Deutschland

In 2007, the Robert Koch Institute established the infrastructure for the national Antimicrobial Resistance Surveillance (ARS) system. Laboratories submit data of routine susceptibility testing of clinical samples from hospitals as well as from outpatient care settings in a standardized format to the Robert Koch Institute for central processing. The database for the period 2008–2011 comprises data of about 1.3?million samples from patients in hospital care and almost 800,000 samples from outpatients. Based on SIR interpretations of susceptibility, the trends of methicillin resistance of Staphylococcus aureus (MRSA) and cefotaxime non-susceptibility as an indicator of extended-spectrum beta-lactamases (ESBL) of Escherichia coli and Klebsiella pneumoniae were analyzed for four care settings or categories: hospital care, outpatient care, intensive care units, and isolates from blood cultures. After constant high levels of above 20%, the proportion of MRSA isolates showed a decline for the first time from 2010 to 2011 in hospital care overall, in intensive care units as well as in blood cultures; in outpatient care, MRSA proportions of about 13% were observed. Within the observed period, non-susceptibility to cefotaxime as an indicator of ESBL in E. coli showed an increasing trend in hospital care at a level above 10% in intensive care units, while cefotaxime non-susceptibility in K. pneumoniae was more frequent but without any trend. In outpatient care, the proportions of cefotaxime non-susceptibility increased year by year in both species resulting in nearly a doubling to 6%.     

Tendenzen in der Literatur zur Sexualerziehung

Ohne Zusammenfassung     

Erziehung zur Familienplanung

Zusammenfassung Bis heute ist das Problem der Familienplanung fast ausschließlich als Problem der sozialen Medizin angesehen worden. Verelendung der Familie durch zu große Kinderzahl, Überbeanspruchung der Familienmutter durch zu rasche Folge der Geburten, Schädigung der Volksgesundheit durch kriminelle Aborte standen im Vordergrund. Man glaubte, durch Aufklärung über die Möglichkeiten der Empfängnisverhütung, durch Legalisierung des Abortes bei Krankheit der Frau den Übelstand beheben zu können. Man glaubte, den Familien und vor allem den überlasteten Frauen wirksame Hilfe zu bringen. Diese Ansicht muß heute bis zu einem gewissen Grade revidiert werden. Man bedachte zu wenig, daß die Anwendung wirksamer, empfängnisverhütender Mittel eine sexualethische Grundlage voraussetzt, die nicht ohne weiteres vorhanden ist, die vielmehr erst geschaffen werden muß. Es gilt nun, in der Jugenderziehung den Boden für das spätere sexualethische Verhalten zu legen. Sexuelle Erziehung ist dabei nicht nur Aufklärung, soll sie doch Richtlinien vermitteln für das Verhalten des Einzelnen dem Du und der Allgemeinheit gegenüber und wird so zum integrierenden Bestandteil der allgemeinen Erziehung. Als Frucht der Erziehung dürften wir dann bewußte und verantwortungsbewußte Elternschaft erwarten.

---

Résumé Jusqu'à maintenant, le problème de la maternité consciente (Family planning) était presque exclusivement un problème de la médecine sociale. L'appauvrissement de la famille par un nombre d'enfants trop grand, surmenage de la mère de famille par la suite des accouchements trop accélérée, détérioration de la santé publique par les avortements criminels se trouvait à l'avant-scène. On croyait améliorer la situation en instruisant les possibilités du birth control et en légalisant l'avortement chez la femme malade. On croyait apporter de l'aide efficace aux familles et aux femmes surmenées. Ce point de vue doit être révisé jusqu'à un certain point. On s'imaginait trop peu que l'application de remèdes contraceptifs efficaces demandait avant tout une base éthique sexuelle, qui n'est pas à présumer, mais qui doit être formée avant tout. Il s'agit done maintenant de fonder dans le futur une véritable base éthique sexuelle dans l'éducation. L'éducation sexuelle doit alors donner des lignes de conduite au comportement de l'individu envers du prochain et de la communauté. Elle est une partie intégrante de l'éducation commune. Nous pourrons alors expecter comme fruit de cette éducation le sens de la parenté consciente.

---

---

Vortrag, gehalten an der Tagung der International Planned Parenthood Federation I.P.P.F. in Berlin 23. bis 29. Oktober 1957.     

Beitrag zur Cadmiumvergiftung

Zusammenfassung Die Cadmiumvergiftung führt zu einem charakteristischen Symptomenbild. Cadmiumsaum, Geruchsbeeinträchtigung, gastrointestinale Störungen, Abmagerung, Anämie und Senkungsbeschleunigung lassen eine spezifische Giftwirkung vermuten. Tierexperimentell gelingt der Nachweis von Serumeiweiß- und Lipoproteinverschiebungen bei gleichzeitiger Zunahme des Gesamteiweißgehalts des Serums. Eine leichte Proteinurie und ein erheblicher Anstieg der Blutsenkungsgeschwindigkeit gehören zu den konstanten Beobachtungen; das Ausbleiben des normalen Gewichtsanstieges, die Entwicklung einer hypochromen Anämie und einer leichten Eosinophilie im Verlauf der subakuten Vergiftung werden beschrieben.Mit 8 Textabbildungen     

Gen-Immuntherapie zur Gen-Immuntherapie zur Behandlung von Malignomen Behandlung von Malignomen

To the current knowledge, cancer cells could be controlled by the immune system. T cells detect tumor cells by recognizing peptides (tumorantigens), which are processed and presented in the context of major histocompatibility complexes (MHC). In contrast to normal tissues, tumor cells present a different kind and/or amount of peptides by MHC. This can result in a selective destruction of cancer cells by cytotoxic T cells, thereby preserving normal tissues. However, after cancer appears, this surveillance often fails. A variety of reasons may be responsible: Loss of capability to process or present tumor antigens, decreased expression of co-stimulatory molecules and an insufficient T cell repertoire may result in an inadequate immune response to tumor cells. Cancer gene therapy strategies are aiming at enhancing the antigenecity of tumor cells and/or the stimulation of tumorantigen specific T cells. These approaches appear especially attractive for the treatment of minimal residual disease.     

Wissenstransfer zur Reproduktionsmedizin

Background

The Internet in general and digital social networks in particular are increasingly important sources for health information; this also applies to information in the context of treatment of patients wishing for a baby. Initial studies show that patients are not only looking for factual information but also for emotional support. Whether digital social networks add to or compete with classical information and consulting is still unclear.

Methods

In order to provide a preliminary answer to this question, a literature study was conducted to determine relevant empirical findings regarding the use of the Internet and digital social networks. This was done using a keyword search in literature databases and then keyword snowballing.

Results

Information and advice from the Internet and from digital social networks can be seen as an addition to medical expertise, but are not a substitute. Digital social networks, in particular, supplement social peer groups and the relationship with physicians and will become even more important in the future.

Conclusion

For professionals active in the field of reproductive medicine, this could be an indication of deficits with regard to counseling and treatment, which in the future might be countered by providing new services.

     

Epidemiologische Daten zur Nahrungsmittelallergie in Europa

The interpretation of epidemiological data on food hypersensitivities should clearly separate two issues: the disposition to respond symptomatically to certain foods and the actual reactions occurring, which can be observed only when there is sufficient consumption or targeted exposure/provocation.