Physicians and the dying: a historical sketch.

The tradition fo Western medicine established during the period of classical antiquity and extending through the early modern period encouraged the physician to avoid or to refuse to treat the seriously and/or terminally ill patient. The cultural environment and general attitudes toward death and dying helped to maintain this practice. Since the nineteenth century, however, the physician has increasingly accepted more responsibility, until he has become the central figure in management of the terminally ill patient. This paper examines the evolution of the relationship between the physician and the dying patient with the intention of illuminating various factors which helped to determine that relationship.     

Home care the American way: an historical analysis

An historical inquiry, this study examines a 100 year tradition of home-based nursing care in the United States. Whether considering turn of the century origins or contemporary re-emergence, the continuities in organization and delivery of home-based care are apparent and striking. Most remarkable in the American saga of home-based care are our dependence on local definition of perceived need and appropriate response; the amount of individual ingenuity required to obtain care from an often confusing assortment of competitive, duplicative and fragmented home care services; and our reliance on public sentiment and devotion to individual freedom rather than more "rational" planning methods.     

The population health approach in historical perspective

The origin of the population health approach is an historic debate over the relationship between economic growth and human health. In Britain and France, the Industrial Revolution disrupted population health and stimulated pioneering epidemiological studies, informing the early preventive public health movement. A century-long process of political adjustment between the forces of liberal democracy and propertied interests ensued. The 20th-century welfare states resulted as complex political mechanisms for converting economic growth into enhanced population health. However, the rise of a "neoliberal" agenda, denigrating the role of government, has once again brought to the fore the importance of prevention and a population health approach to map and publicize the health impacts of this new phase of "global" economic growth.     

Advocating voice: organisational, historical and social milieux of the Alzheimer's disease movement

The Alzheimer's disease movement, despite the stated willingness of the Alzheimer's Association, has yet to comprehensively utilise people with Alzheimer's as spokespersons. This is particularly noteworthy given the increasing availability of those with Alzheimer's who, especially in the early stages, are fully capable of advocating their position. Qualitative interviews and focus groups with people who have been diagnosed with Alzheimer's demonstrate the active role they are beginning to take in informing research, practice and policy. Interviews with affiliates of the national association aiming to advocate for people with memory loss depict an enduring struggle to incorporate these perspectives. Although primary obstacles may involve the structural dynamics within a society that stigmatises those who are old and/or forgetful, there are clear organisational contradictions within the Association itself preventing such mobilisation efforts. The dynamics shaping this health social movement's endeavours portray characteristics that obstruct an ability to embrace as spokespersons the individuals for whom it advocates.     

An historical review of multiphasic screening

The term multiphasic screening was first applied to a health survey in San Jose, California in 1949. That survey was designed to detect previously unrecognized chronic diseases for which screening tests were then available and for which therapy would presumably be helpful.It appeared that patients with chronic conditions, both communicable and non-communicable, would do better if the diseases were discovered and treated early. Recognizing the importance of this concept, public health workers sought to develop and apply tests for the detection of such conditions even among persons who did not realize they were affected, as a means of improving their prospects for health. The leaders of these early efforts, however, recognized certain limitations of screening surveys. In particular, they emphasized that the tests were not diagnostic; mass testing was seen as merely the first step to medical care.The multiphasic survey was conceived with a view to combining several of these tests in one “package”. In addition to being more effective than screening for single diseases, multiphasic screening was also seen as having relationship to periodic health examinations.Although multiphasic screening encountered initial resistance, it did take root in two group-practice prepayment plans in the early 1950's, the Kaiser Plan in the San Francisco Bay Area and the Health Insurance Plan of Greater New York (HIP).Besides serving as an element of health care, particularly for modern preventive medicine and health maintenance, multiphasic screening also shows promise as a device for research into the nature of disease. By 1970, its use appeared to be accelerating. The current application of advanced technology, particularly automation based on electro-mechanical devices, gives promise for greater speed in analyses and promotion of similarity of laboratory procedures in previously diverse fields. Automated multiphasic screening opens the possiblity of extending the health-maintenance type of health care to all groups of the population and may provide the basis for redirecting medicine in the future.     

Limited impact of the breast self-examination movement: a Latin American illustration

Analysis of data obtained through a survey of women in Monterrey, Mexico, indicates that the transfer of breast self-examination (BSE) technology from the medical community to the Monterrey public has been inefficacious. Only 1 in 200 women reported monthly breast self-examination performed correctly and at the optimal time of the month. Among women who reported examining their breasts monthly, transfer of BSE technology, whether by medical or non-medical sources, was unrelated to knowledge of correct time and method of BSE. Personal instruction of BSE technology by physician failed to produce the desired response since 80% of the respondents were taught BSE technique in 'one-shot', short sessions. The findings indicate that, ultimately, the success of BSE in improving disease outcomes rests with the medical community more than with the patient population. Success will only follow more intense initial instruction and persistent reinstruction of women in BSE. The implications of these findings for current research seeking to evaluate BSE influence on cancer outcomes are noted.     

一个实践型的美国学者——记凤凰医院集团公司高级顾问、美国医院管理专家LOUIS RUBINO博士

"中国通" 2002年仲夏,一位美国学者冒着炎炎酷暑先后在广州、深圳、大连、哈尔滨和上海等地连续作了七场学术报告.他风尘仆仆,侃侃而谈,所到之处,均受到热烈欢迎.他演讲的题目为:"美国医疗卫生制度概览"、"现今美国医院管理者所面临的问题"、"为什么美国的医院管理者大多不是学医的"、"当今中美医院管理的比较"等.人们不仅被其精彩的演讲所吸引,更惊异于他对中国问题的熟悉.不少听众甚至称他为医院管理的"中国通".这个目光炯炯、有着意大利血统、留着一头卷发的高个子美国人就是美国加州州立大学卫生科学系教授、美国医院管理者学会会员、中国凤凰医院集团公司高级顾问、美国凤凰医院管理公司CEO和中国中山大学管理学院客座教授LOUIS RUBINO博士.