Migraine and the presidency

The disclosure that 2012 presidential candidate Michele Bachmann has migraines resulted in intense public and physician interest in the migraine of presidents, migraine and potential presidential disability, and the politics of migraine that are reviewed in this article. Jefferson had severe headaches that may have been a migraine variant. Lincoln, Grant, and Wilson were, John Adams and Eisenhower might have been, and Truman and Kennedy may have been migraineurs. First Ladies Abigail Adams, Lincoln, Eisenhower, and Kennedy all suffered from migraines. Although migraines can usually be effectively treated, disabling attacks could occur because of the accentuated triggers of office that could prevent a future president from being temporarily able to discharge the duties of office. The 25th amendment is available to voluntarily transfer powers of office to the vice president even for a short period of time. The current $13 million per year in research funding provided by the National Institutes of Health is clearly inadequate to the task of improving treatment for such a pervasive, disabling disease that so profoundly affects so many Americans including presidential candidates, presidents, and first ladies. A survey of the Southern Headache Society on migraine and presidential disability is also presented.     

The cover-up of president Urho Kekkonen's dementia and its impact on the political life of Finland-a personal account.

Urho Kekkonen, born in 1900, was elected President of Finland in 1956. He stayed in office for 25 years, the longest term for any democratically elected chief of state, until his resignation in 1981. Since he was always a model of good health, news of his cognitive decline while still in office came as a surprise to the whole nation. The impact was aggravated by an attempted cover-up of his dementia. The attempt failed and the health of presidential candidates became, suddenly, a topic of intense public discussion. No special team of presidential doctors was established but Kekkonen's successor initiated a practice of reporting annually on his health. The ethical dilemma involving mass media was, and still is, its duty to inform people versus its right to self-censorship, which was practised in Kekkonen's case. The physicians face the question of when, how and whom to inform when they notice that the president or some other powerful leader suffers from cognitive decline or other neuropsychological or mental disability. These are universal problems whose solution depends on the degree of democracy and freedom of expression in each country. Kekkonen died in complete privacy in 1986. Until now, no scientific report of his cognitive decline has been published.     

Fatal Spinal Cord Injury of the 20th President Of The United States: Day–By-–Day Review Of His Clinical Course,With Comments

Abstract

Background: This article presents the medical history of the 20th president of the United States, James A. Garfield, with an emphasis on hisspinal cord injury (SC I). Numerous references debate the care he received from the medical and surgical perspectives, but little has been written about the essential aspect of his gunshot wound-namely, the darnage to his spinal cord. President Garfield was shot in the lumbar spine and was bedridden until he died 80 days following his injury. This article contrasts state-of-the-art care in 1881 to today’s standards of care for SCI.

Method: Literature review. Arecord of daily reports of the president’s condition was analyzed. Comparisons were made between the president’s care and what is now available.

Findings: Although the president had access tothebest physicians, the chronicle of his course underscores the deficiencies in basic medical care, the controversies concerning surgical intervention, and the problems inherent in the care of a prominent patient. Press releases did not overtly address spinal cord trauma and its complications so as to avoid conveying the president’s degree of incapacity. Garfield ’s SCI was documented on autopsy. The bullet entered the 1Oth intercostal space, 3 112 inches to the right of the spinous processes, fracturing the 11th and 12th vertebrae and nicking the Tl 2-L 1 disc. The bullet then passed through the right side of the body of L 1 and exited the vertebra anteriorly and to the left and lodged behind the pancreas, where it was found encased by a firm cyst.

Conclusion: Deficiencies in general medical care and surgical technique at the time contributed to the president’s demise. This case was marked by controversies that still are debated today-for example, whether the bullet should have been removed surgically. Examination of available evidence suggests that with today’s advances in medical, surgical, and SCI medicine, a person with this type of injury would likely survive and be a candidate for rehabilitation.     

Feasibility and acceptability of an integrated behavioral medicine service within a post–bariatric surgery clinic

BackgroundLong-term medical and psychological follow-up after weight loss surgery is associated with improved patient outcomes. Weight regain after weight loss surgery is a common concern that has behavioral and psychological components; however, most patients do not attend behavioral medicine (BMED) follow-up appointments post-surgery. Innovative treatment models are needed to improve access to BMED to optimize long-term outcomes.ObjectivesThis study aimed to examine the feasibility and acceptability of an integrated BMED service within a bariatric surgery clinic.SettingUniversity medical center, outpatient clinic.MethodsPatients (n = 198) in a post–bariatric surgery clinic were screened for psychosocial/behavioral concerns and offered a same-day BMED consult, when appropriate. Patients rated their satisfaction with the consult and their confidence in being able to carry out the plan created during the consult.ResultsThe top 3 concerns identified during screenings were emotional eating, body image, and cravings. The top 3 concerns addressed during consults were emotional eating, mood, and cravings. The mean length of consult was 26.1 minutes. The mean severity of problems addressed was 7 of 10. Patients’ confidence ratings had a mean of 9.4 of 10 (1 = low, 10 = high) and satisfaction ratings had a mean of 9.8 of 10.ConclusionsIn this clinic, the integration of a BMED service provided 40% of patients with behavioral intervention for psychosocial/behavioral concerns during routine surgery follow-up appointments. Patients indicated high satisfaction with consults and reported high confidence in being able to carry out the plan created during the consult.     

Achievements in hypertension: A 25 year overview

Only 25 years ago, the field of hypertension was challenged by retrospective clinical data and epidemiologic information suggesting that an elevated arterial pressure is a major risk factor for enhanced cardiovascular morbidity and mortality. Not only was antihypertensive therapy looked on by many as dangerous and fraught with severe and undesirable side effects, but its validity in reversing the course of disease was not yet demonstrated. This review discusses the dramatic new information amassed over the past 25 years that points to the new physiologic and clinical concepts concerning hypertension. It considers impressive new diagnostic techniques and methods designed to identify secondary forms of hypertension and target organ involvement. In summary, it outlines the feasibility of reversing overall (and cardiovascular) morbidity and mortality with an array of antihypertensive agents that provide the therapeutic ability to suppress most pathophysiologic pressor mechanisms of hypertensive disease. The lesson is clear: hypertension provides the greatest available challenge to the new era of preventive cardiology in the 21st century.     

The impact of hazards in art on female workers

In the last few years, artists and craftspeople have become concerned about the hazards of arts and crafts materials. Most artists and craftspeople have been working with a wide variety of toxic materials without adequate precautions and usually without even the knowledge that these materials were hazardous. Studies show that 78.5 million people are engaged in arts and crafts, of which at least half a million are professional artists and craftspeople. Of the latter, at least 50% are women. Artists and craftspeople face many of the same occupational health hazards as are found in the more conventional workplace. Since most artists work at home, there are additional risks, such as 24-hr exposures and exposure of other family members. Women artists also face additional hazards to themselves and the embryo during pregnancy and to the infant during breast-feeding. Artists and craftspeople often find it difficult to obtain proper diagnosis of art material-related illnesses. This can be a more serious problem for women who are often stereotyped as subject to psychosomatic illnesses and hypochondria. Finally, the article discusses basic precautions that can be taken by artists and craftspeople to work safely with their materials.     

落实党委领导下的院长负责制的实践与思考

党委领导下的院长负责制是国家建立现代医院管理制度、深化公立医院改革的重大举措。文章总结归纳了复旦大学附属华山医院运用组织行为学理论,从管理层次和管理幅度两个维度对管理体制进行重构的实践经验,探讨了如何充分发挥党委领导的核心和引领作用,将党的领导融入医院治理各环节,为其他公立医院开展相关工作提供了参考。     

公立医院院长岗位职责与知识结构认知研究

目的 通过研究公立医院院长岗位职责和知识结构,为公立医院院长应具备的岗位职责和知识结构研究提供参考依据。方法 在查阅相关文献的基础上,通过专家小组讨论,归纳总结公立医院院长岗位职责,并采用问卷调查的方式调查四川省公立医院院长岗位职责及知识构成重要性的认知情况。结果 公立医院院长认为推行优质医疗卫生服务、探索合理的激励分配方式、维护公立医院公益性质等岗位职责较为重要,重要性打分依次为4.63、4.55、4.52分。就知识结构重要性而言,其认为管理学知识较为重要。结论 明确公立医院院长岗位职责,为公立医院院长任期考核提供依据;加强管理学知识培训,推动院长职业化发展。