Global health in the making: health demonstration areas in Europe, 1950s and 1960s / Construcción de la salud global: zonas de demostración sanitaria en Europa, décadas de 1950 y 1960

Abstract Global health is a multifaceted concept that entails the standardization of procedures in healthcare domains in accordance with a doctrine agreed upon by experts. This essay focus on the creation of health demonstration areas by the World Health Organisation (WHO) to establish core nodes for integrated state-of-the-art health services. It explores the origins, theoretical basis and aims of this technique and reviews several European experiences during the first 20 years of the WHO. Particular attention is paid to the historical importance of technical cooperative activities carried out by the WHO in regard to the implementation of health services, a long-term strategic move that contributed to the thematic upsurge of primary health care in the late 1970s.

Resumen Salud global es un concepto complejo que implica la normalización de los procedimientos de actuación sanitaria siguiendo una doctrina acordada por expertos. Este trabajo se ocupa del establecimiento de zonas de demostración sanitaria por la Organización Mundial de la Salud (OMS) a modo de núcleos de modernos servicios sanitarios integrados. Revisa el origen, las bases téoricas y los objetivos de esta técnica y examina diversas experiencias europeas durante los primeros veinte años de la OMS. Pone de manifiesto la importancia histórica de las actividades de cooperación técnica de la OMS en la puesta en marcha de servicios sanitarios, una estrategia de largo plazo que ayuda a entender la aparición de la atención primaria de salud a finales de la década de 1970.

Zeus' pain: did he experience a thunderclap headache? / A dor de Zeus: fora ele acometido por uma cefaleia em trovoada?

Zeus is known as the king of the gods and god of the sky. His attributes are lightning and thunder and he is often depicted about to hurl them. According to Greek mythology, Zeus molested the titan Metis and decided to swallow her when she was pregnant, which resulted in an excruciating headache, only relieved after a craniotomy performed using Hephaestus' axe. The result of this procedure was the birth of Athena, Zeus' daughter. We conducted a combined analysis of some writings such as the classical mythological poem Theogony by Hesiod, and some other books that examine and retell myths and legends of ancient Greece, with medical papers on this topic, trying to characterize Zeus' headache. Would it be possible to fit Zeus' headache into the group of thunderclap headaches?

Zeus é conhecido como rei dos deuses e deus dos céus. Tem como atributos os raios e os trovões e é frequentemente representado prestes a lançá-los. De acordo com a mitologia grega, Zeus molestou a titã Métis e resolveu engoli-la grávida, o que resultou em uma cefaleia excruciante, apenas aliviada após uma craniotomia realizada por meio do machado de Hefesto. O fruto deste procedimento foi Atena, filha de Zeus. Realizamos uma análise combinada utilizando escritos mitológicos clássicos como o poema Teogonia de Hesíodo, além de outros livros sobre mitologia e artigos médicos que tratam deste tema, para tentar caracterizar a cefaleia de Zeus. Seria possível enquadrar a cefaleia de Zeus no grupo das cefaleias em trovoada?

Belleza plástica, eugenesia y educación física en Chile: presentación de la fuente "Aspectos de la educación física", de Luis Bisquertt (1930) / Plastic beauty, eugenics and physical education in Chile: a commentary on the work "Characteristics of physical education", by Luis Bisquertt (1930)

Resumen El siguiente texto busca presentar y contextualizar la fuente "Aspectos de la educación física", de Luis Bisquertt, poniendo énfasis en la búsqueda del mejoramiento racial en Chile de 1930, a partir de la educación física eugénica, cuyo paradigma corporal serían las estatuas clásicas helénicas. Uno de los conceptos centrales de este documento es el de belleza plástica, cuyo sentido se encuentra totalmente imbricado a la idea de normalidad y sanidad, patologizando aquellos cuerpos que no se enmarquen en el canon atlético, situación extendida por las características sedentarias de la modernidad.

Abstract The article seeks to introduce and contextualize the work "Characteristics of physical education" ("Aspectos de la educación física"), by Luis Bisquertt, which emphasizes the effort to ameliorate racial aspects in Chile, in 1930, thru physical education eugenics, whose body paradigm were the Hellenic classical statues. One of the key concepts of this document is plastic beauty, whose meaning overlaps with the idea of normality and sanity, creating pathologies on those bodies that were considered outside of the athletic standards, a situation that was aggravated by the sedentary conditions of modern times.

Medical Philosophy in Ancient Greece and Its Enlightenment / 中国医学伦理学

Medical philosophy has important guiding significance for the development of medicine. Ancient Greek medical philosophy has rich connotation and strong vitality. In the study of ancient Greek medical philosophy and combined with"the positioning of basic medicine"and"doctor-patient relationship"and other outstanding is-sues in the current development of medicine, we found that the rational examination of medical theory and medical treatment in ancient Greek medical philosophy, ways of thinking and analytical methods of medical philosophy and the character that physician should have had an important value in the development of modern medicine. We should pay attention to basic medical research,pursue innovative thinking, be good at using critical thinking and pay atten-tion to the training of humanistic spirit among medical workers.

Recovery and Return to Work After a Pelvic Fracture

BACKGROUND: Pelvic ring fractures (PRFs) may influence the daily activities and quality of life of the injured. The aim of this retrospective study was to explore the functional outcomes and factors related to return to work (RTW) after PRF. METHODS: During the years 2003–2012, 282 injured individuals aged 20–55 years on the date of the accident, were hospitalized and treated for PRFs in a large tertiary hospital in Athens, Greece. One hundred and three patients were traced and contacted; 77 who were on paid employment prior to the accident gave their informed consent to participate in the survey, which was conducted in early 2015 through telephone interviews. The questionnaire included variables related to injury, treatment and activities, and the Majeed pelvic score. Univariate and multiple regression analyses were used for statistical assessment. RESULTS: Almost half of the injured (46.7%) fully RTW, and earning losses were reported to be 35% after PRF. The univariate analysis confirmed that RTW was significantly related to accident site (labor or not), the magnitude of the accident's force, concomitant injuries, duration of hospitalization, time to RTW, engagement to the same sport, Majeed score, and complications such as limp and pain as well as urologic and sexual complaints (p < 0.05 for all). On multiple logistic regression analysis, the accident sustained out of work (odds ratio: 6.472, 95% confidence interval: 1.626–25.769) and Majeed score (odds ratio: 3.749, 95% confidence interval: 2.092–6.720) were identified as independent predictive factors of full RTW. CONCLUSION: PRFs have severe socioeconomic consequences. Possible predictors of RTW should be taken into account for health management and policies.

First report of Dientamoeba fragilis infection explaining acute non-specific abdominal pain.

Dientamoeba fragilis is now considered a potentially emerging gastrointestinal pathogen in both developing and developed countries. We first report an autochthonous case of D. fragilis infection in Greece. A 49‑year‑old female with acute non‑specific abdominal pain required emergency surgical admission for active observation and repeated assessment. To the best of our knowledge, this is the first reported case of acute unexplained abdominal pain finally attributed to D. fragilis infection using microscopic and molecular methods.

Medical students' satisfaction with the Applied Basic Clinical Seminar with Scenarios for Students, a novel simulation-based learning method in Greece / 보건의료교육평가

PURPOSE: The integration of simulation-based learning (SBL) methods holds promise for improving the medical education system in Greece. The Applied Basic Clinical Seminar with Scenarios for Students (ABCS3) is a novel two-day SBL course that was designed by the Scientific Society of Hellenic Medical Students. The ABCS3 targeted undergraduate medical students and consisted of three core components: the case-based lectures, the ABCDE hands-on station, and the simulation-based clinical scenarios. The purpose of this study was to evaluate the general educational environment of the course, as well as the skills and knowledge acquired by the participants. METHODS: Two sets of questions were distributed to the participants: the Dundee Ready Educational Environment Measure (DREEM) questionnaire and an internally designed feedback questionnaire (InEv). A multiple-choice examination was also distributed prior to the course and following its completion. A total of 176 participants answered the DREEM questionnaire, 56 the InEv, and 60 the MCQs. RESULTS: The overall DREEM score was 144.61 (±28.05) out of 200. Delegates who participated in both the case-based lectures and the interactive scenarios core components scored higher than those who only completed the case-based lecture session (P=0.038). The mean overall feedback score was 4.12 (±0.56) out of 5. Students scored significantly higher on the post-test than on the pre-test (P<0.001). CONCLUSION: The ABCS3 was found to be an effective SBL program, as medical students reported positive opinions about their experiences and exhibited improvements in their clinical knowledge and skills.

The dialectics of new fascism in Greece / A dialética do novo fascismo na Grécia

The success of historical fascism in the particular transitional period at the beginning of the 20th century was grounded in its contribution to the successive acceptance and application of the so-called Fordist model for the organization of labor (accompanied by the correspondent social conditions and relations). Historical fascism contributed thus, with its particular way, to establishing a new class compromise between the potentials related with the productive forces and the confinements emanating from the productive relations. This contribution constitutes the "creativity" of fascism. Such a historical perspective on social processes allows us not to fall into the trap of understanding fascism only as a (barbarian) "deception". Fascism cannot be a plain deception, because a "mere deceit" cannot mobilize people. Fascism takes over, adopts real and unfulfilled needs and hopes - which as such constitute resistance to the capitalist arrogance and logic of commodification of everything - and offers its own (fascist, barbarian) solution or fulfillment. Consequently, our responsibility cannot lie in rejecting these needs and hopes (which are basically needs and hopes for security) because of their distorted or "pervert" articulations. Our responsibility lies in the careful peeling of these hopes/demands from their (fascist) enwrapment. Nationalism (from the subalterns!) does not constitute a mere irrational leftover from the past, but contains potentially mystic and romantic pre- or anti-capitalist elements and references. Nationalism obtains its dynamics and persuasion (for the subalterns!) from and for the contemporary societal processes, thus constituting an active, political and actual demand/position within the restructuring of society - which is in itself a moment in the restructuring of capitalism. Herein also the "rational kernel" of the anti-capitalist antithesis by the New Right is founded as counter position to the "neutral"...

O sucesso do fascismo histórico no período de transição, em particular no início do século 20, foi baseado em sua contribuição para a aceitação e aplicação sucessiva do chamado modelo fordista para a organização do trabalho (acompanhada das condições e relações sociais correspondentes). Fascismo histórico contribuiu assim, em sua forma particular, com a criação de um novo compromisso de classe entre os potenciais relacionados com as forças produtivas e as prisões que emanam das relações produtivas. Esta contribuição constitui a "criatividade" do fascismo. Tal perspectiva histórica sobre os processos sociais, não nos permite cair na armadilha de se compreender o fascismo apenas como um (bárbaro) "engano". O fascismo não pode ser um engano simples, porque um "mero engano" não pode mobilizar as pessoas. Fascismo assume, adota necessidades e esperanças reais e não cumpridas - que, como tal, constituem resistência à arrogância capitalista e lógica da mercantilização de tudo -, e oferece a sua própria solução (fascista, bárbara) ou sua realização. Por conseguinte, a nossa responsabilidade não pode mentir em rejeitar essas necessidades e esperanças (que são, basicamente, precisas e esperar pela segurança) por causa de suas articulações distorcidas ou "pervertido". Nossa responsabilidade exige-nos cuidadosas esperanças e demandas de seu (fascista) envolvimento. Nacionalismo (a partir dos subalternos!) não constitui uma mera sobra irracional do passado, mas contém potencialmente elementos anticapitalistas e referencias pré-místicas e românticas. Nacionalismo obtém sua dinâmica e persuasão (para os subalternos!) de e para os processos sociais contemporâneos, constituindo, assim, uma demanda/posição ativa, política e real no âmbito da reestruturação da sociedade - que é em si mesmo um momento na reestruturação do capitalismo. Aqui também o "núcleo racional" da antítese anticapitalista pela Nova Direita é fundada como posição contrária à mercantilização...

A 2-Year Psychological Autopsy Study of Completed Suicides in the Athens Greater Area, Greece

OBJECTIVE: To study the characteristics of a sample of suicide victims from the Athens Greater Area using the psychological autopsy method for the first time in Greece. METHODS: We studied all recorded cases of completed suicide for the 2-year time period November 2007-October 2009 collecting data from the victims' forensic records as well as from the completion of a psychological autopsy questionnaire. RESULTS: 335 persons were recorded as suicide victims. We contacted relatives of 256 victims interviewing those of 248 of them (96.9%). The differences regarding sex, marital and employment status between our sample and the general population were statistically significant (p<0.001). The male/female ratio was 3:1. Comparatively more victims were divorced, separated or single and a greater proportion were pensioners or unemployed. 26.0% of the victims had history of prior attempts (64.4% once, 20.3% twice and 15.3% more times). 42.6% were taking psychiatric medication-significantly more women than men according to blood tests; 14.2% had been hospitalized in a psychiatric clinic the year prior to their death. 84.8% have deceased at the place of suicide and 15.2% died in the hospital; 80.3% died indoors and 19.7% outdoors. Men died primarily by hanging or shooting by a firearm while women preferred jumping from height instead (p<0.001). As many as 48.8% had expressed their intention to die to their relatives; 26.6% left a suicide note. CONCLUSION: Our study has shown that the psychological autopsy method is applicable and widely accepted yielding results comparable to the international literature. Specific parameters associated with suicide have been studied for the first time in Greece.

Disseminated Bacillus Calmette-Guerin infections after intravesical therapy.

Intravesical instillation of Bacillus Calmette-Guerin (BCG) is the treatment of choice for superficial bladder carcinoma. Disseminated BCG infection presenting as granulomatous hepatitis or pneumonitis is a very rare complication of this treatment. Here we report a case series of seven patients previously treated with BCG presenting with pneumonitis. In two of the cases, identification of Mycobacterium bovis was achieved with molecular methods.

Influence of Shiftwork on Greek Nursing Personnel

BACKGROUND: The aim of this study was to investigate the burden experienced by nursing personnel working irregular shifts in Greece and to conduct the first test of a Greek version of the Standard Shiftwork Index (SSI). METHODS: A cross-sectional survey was carried out. The SSI was completed by 365 nurses and nursing assistants working shifts, including nights. RESULTS: Female nursing personnel and those suffering from a chronic disease were most affected by working rotating shifts as they had elevated scores on the majority of the SSI scales, such as sleep, chronic fatigue, digestive and cardiovascular problems, general health questionnaire, cognitive and somatic anxiety, shift time satisfaction, engagement and disengagement strategies, languidity, flexibility, and neurotisicm. Nurses with longer working experience and those with family responsibilities also scored higher on some of the SSI scales, such as the sleep, shift time satisfaction, social and domestic disruption, disengagement strategies, morningness, and languidity scales. CONCLUSION: Shiftwork affects female nurses, those with chronic disease, older age, and domestic responsibilities more severely. Therefore management should take these factors into account when designing work schedules to alleviate the burden caused by shiftwork.

Influence of Protein Intake from Haem and Non-haem Animals and Plant Origin on Inflammatory Biomarkers among Apparently-healthy Adults in Greece.

Intake of different types of protein may be associated with differences in biomarkers among various populations. This work investigated the influence of protein intake from haem and non-haem animals as well as protein from plants on haematological and biochemical parameters in inflammation among apparentlyhealthy adults living in Greece, a Mediterranean country. Four hundred and ninety apparently-healthy subjects (46±16 years, 40% men), who consecutively visited Polykliniki General Hospital for routine examinations, voluntarily agreed to participate in the study (participation rate 85%). Demographic, anthropometric and lifestyle characteristics were recorded. Participants completed a valid, semi-quantitative food frequency questionnaire. Protein intake was classified into three sources: protein from haem animals, protein from non-haem animals, and protein from plant origin. Fasting blood samples were taken from all participants; uric acid, creatinine, lipids, cystatin C, haptoglobin, haemoglobin, haematocrit, iron, ferritin, white blood cells, monocytes, platelets, and C-reactive protein were measured. Protein intake from only haem animals was associated with increased haemoglobin and haematocrit levels (p<0.05) whereas intake of protein from non-haem animals and plant origin was not associated with the investigated haematological and biochemical markers of low-grade chronic inflammation when lifestyle factors and overall dietary habits were taken into account. Intake of protein from only haem animals seems to be consistently associated with haematological markers. The confounding role of dietary habits and lifestyle variables on the tested parameters deserves further attention in future research.

Mediterranean fever gene mutations in greek patients with Behcet's disease / Mutacionesen el gen de la fiebre mediterránea en pacientes griegos con la enfermedadde Behçet

OBJECTIVE: It is known that clinical similarities between Behcet's disease and Familial Mediterranean Fever have led to the hypothesis of a common pathogenesis. Familial Mediterranean Fever is caused by MEFV gene mutations coding for pyrin. Therefore, we examined whether these pyrin mutations are also associated with Behcet's disease. METHODS: Molecular testing for pyrin mutations was performed in 96 unrelated Greek patients with an established diagnosis of Behcet's disease. The results were compared with an analysis for pyrin mutations in 140 unrelated healthy Greek controls. RESULTS:We found no pyrin mutations among the Behcet cases tested; this result is comparable with the control group. CONCLUSIONS: Pyrin gene mutations in Greek patients with Behcet's disease are not more common than those in the general population. This finding is not in agreement with the findings in other populations. It is suggested that screening for pyrin mutations not be included in the evaluation of Greeks suspected to have Behcet's disease.

OBJETIVO:Se sabe que las similitudes clínicas entre la enfermedad de Behçet y la fiebre mediterránea familiar han llevado a la hipótesis de una patogénesis común. La fiebre mediterránea familiar es causada por mutaciones en el gen MEFV que codifica la pirina. Por lo tanto, examinamos si estas mutaciones de la pirina se hallan también asociadas con la enfermedad de Behçet. MÉTODOS: La prueba molecular para la detección de las mutaciones de la pirina se realizó en 96 pacientes griegos no relacionados, y diagnosticados con la enfermedad de Behçet. Los resultados se compararon con un análisis de las mutaciones de la pirina en 140 controles formados por individuos griegos saludables. RESULTADOS: No se encontraron mutaciones de pirina entre los casos de Behçet sometidos a prueba. Este resultado es comparable con el grupo control. CONCLUSIONES: Las mutaciones del gen de la pirina en los pacientes griegos con la enfermedad de Behçet no son más comunes que las de la población general. Este hallazgo no concuerda con los hallazgos en otras poblaciones. Se sugiere que el tamizaje para la detección de las mutaciones de pirina no se incluya en la evaluación de pacientes griegos sospechosos de padecer la enfermedad de Behçet.

Report on ICMART XV WORLD CONGRESS OF MEDICAL ACUPUNCTURE, 25-27 MAY ATHENS・GREECE 2012 / 全日本鍼灸学会雑誌

The 15th international conference of ICMART was held from the 25th to 27th of May 2012 in Athens, Greece, under the theme of "The Point where all Different Ideas Meet."There were 210 participants. In addition to lectures on general subjects, eight topics were examined in depth during eight separate sessions. Ten workshops were held. The overall quality of the presentations appeared to be high. For visitors who were unable to attend some of the lectures because of lectures being held at the same times, the meeting time was managed in such a way that time for providing summarized explanations on the contents of all lectures was arranged every day. Furthermore, a questionnaire survey was conducted on visitors'motives for attending the conference and on the current situation of acupuncture in various countries. On the basis of the aggregate survey results, discussions were conducted. Starting this year, participation in the conference has been restricted to only physicians and veterinarians. I was allowed to attend the conference at the request of The Japan Society of Acupuncture and Moxibustion, for news coverage. The topic of my report was "the diagnostic results and treatment of the victims of the Great East Japan Earthquake based on traditional medicine."

Early Rescue Administration of Surfactant and Nasal Continuous Positive Airway Pressure in Preterm Infants <32 Weeks Gestation.

Objective: This study reports our institutional experience on the outcome after prophylactic and early rescue endotracheal instillation of surfactant within 20 minutes of birth, followed by extubation and nasal continuous positive airway pressure (NCPAP) in preterm infants <32 weeks gestational age. Patients and methods: A total of 142 infants were prospectively studied (42, gestational age from 23 to 27 and 100, from 28 up to 32 weeks). All infants were electively intubated for administration of 200mg/kg porcine isolated surfactant (Curosurf, Chiesi Farmaceutici SPA, Parma, Italy) as soon as practicably possible (within 20 min after birth) and NCPAP was then initiated. Results: Extubation and switch to NCPAP at 6h was successful in 6/42 (14.3%) infants less than 28 weeks gestational age and 75/100 (75%) infants 28-32 weeks gestational age. Out of 81 infants that were successfully extubated, 76 (93.83%) never required re-ventilation. At 96h of age, need for continuing intubation and ventilation was required by 6/38 (15.8%) alive infants <28 weeks gestational age and 8/100 (8%) infants 28-32 weeks gestational age. Mean duration of NCPAP post-extubation was 38±20 hours for infants 23-27 wks and 29±15 hours for infants 28-32 wks gestational age. The mortality rate was 2.81% (4/142). Conclusion: Implementation of prophylactic or early rescue administration of surfactant with NCPAP in infants at high risk for developing RDS in neonatal ICU is a safe modality of respiratory support in preterm infants.

Alma, corpo e a antiga civilização grega: as primeiras observações do funcionamento cerebral e das atividades mentais / Soul, body and the ancient greek civilization: the first observations of brain functioning and mental activities

Muitos dos conceitos existentes na neurociência moderna possuem suas origens nas especulações elaboradas pelos antigos filósofos e médicos gregos. Questões centrais sobre a fonte dos pensamentos humanos, o mecanismo da atividade cognitiva, e a natureza das emoções, percepção e movimento voluntário, por exemplo, foram levantadas pelos pensadores gregos. É a partir desta civilização que surgem as observações mais sistemáticas sobre a estrutura e o funcionamento do corpo, da mente e a relação entre estas duas entidades. Assim, o presente trabalho pretende observar as principais tentativas iniciais gregas em vincular estruturas do corpo (tais como o cérebro ou o coração) e atividades mentais, ao longo das diversas especulações gregas sobre a natureza, a filosofia, a psicologia e a medicina.

Many of the existing concepts in modern neuroscience have their origins in the speculations made by ancient Greek philosophers and physicians. Core questions about the source of human thought, the mechanism of cognitive activity as well as the nature of emotions, perceptions and voluntary movements, for example, were raised by Greek thinkers. It is from this civilization that arise more systematic observations on the structure and functioning of body, mind and relationship between these two entities. The present paper intends to adhere to the first Greek attempts to link structures of the body (such as the brain or the heart) and mental activities regarding various Greek speculations about the nature, philosophy, psychology and medicine.

Serum Anti-Saccharomyces Cerevisiae Antibodies in Greek Patients with Behcet's Disease

We tested 59 Greek patients with Behcet's Disease (BD) for serum anti-Saccharomyces cerevisiae antibodies. No increase of these antibodies was detected in the cases compared to 55 healthy unrelated blood donors from the same population. This finding is in contrast with the correlation between Saccharomyces cerevisiae antibodies and BD as reported in other populations. It seems that environmental factors may contribute to disease expression in different populations, producing different effects according to the individual's genetic predisposition. Saccharomyces cerevisiae antibodies do not seem to be of any significance in the Greek population.

Validity and Reliability of the Greek Version of the Multiple Sclerosis International Quality-of-Life Questionnaire

BACKGROUND AND PURPOSE: There are no data regarding psychometrically validated, health-related quality-of-life instruments designed specifically for patients with multiple sclerosis (MS) in Greece. Recently, the MS International Quality-of-Life questionnaire (MusiQoL), a multidimensional, self-administered questionnaire, which is available in 14 languages (including Greek), has been validated using a large international sample. We investigated the validity and reliability of the Greek version of the MusiQoL. METHODS: Consecutive patients with different types and severities of MS were recruited from two tertiary-care centers in Greece. All patients completed the MusiQoL, the Short-Form-36 quality-of-life questionnaire (SF-36), and a symptom checklist at baseline and 21+/-7 days (mean+/-SD) later. Data regarding sociodemographic status, MS history, and functional outcome were also collected prospectively. Construct validity, internal consistency, reproducibility, and external consistency were tested. RESULTS: A total of 92 patients was evaluated. The construct validity was confirmed in terms of satisfactory item-internal consistency correlations and scaling success (87.5-100%) of item-discriminant validity. The dimensions of the MusiQoL exhibited high internal consistency (Cronbach's alpha: 0.63-0.96), and reproducibility was satisfactory (intraclass correlation coefficients: 0.69-0.99). External validity testing indicated that the MusiQoL correlated significantly with all SF-36 dimension scores (Spearman's correlation: 0.43-0.76). CONCLUSIONS: The Greek version of the MusiQoL appears to be a valid and reliable instrument for measuring quality of life in Greek MS patients.