[Salomon Neumann (1819-1908) and the Right to Health]. / Salomon Neumann (1819­1908) und das Recht auf Gesundheit.

The "Universal Declaration of Human Rights (UDHR)" of the United Nations (UN) of 1948 sets out a right to health as a common ideal and aspiration. In his writings on the reform of the Prussian Medical Charter "Public Health and property" 100 years before the UDHR was set out, the Jewish physician Salomon Neumann had defined health as a right for every citizen, a right that should to be protected by a public system of health care. His reasoning went beyond contemporaneous critical social discussion. Right of humans to health has been acknowledged nationally and internationally; in the Federal Republic of Germany, the question as to whether there is a basic right to health is still open.

[Design of a Curriculum Clinical Social Medicine]. / Entwurf eines Curriculums Klinische Sozialmedizin.

The economic transformation of health care systems, which is supported by both the economic and the political sector, is in demand of constant humane correction. Legal regulations of social systems securing health corresponding to the code of social law are guard rails for a responsible use of limited resources and are subject to constant development. All doctors caring for patients should be in a position to reflect the real life context of their patients as both causal and modifying influence for health and disease from a social medical perspective, apart from their specific medical field of expertise.Accordingly 3 parts of sub-specialization training are suggested: clinical tasks of social medicine as detailed in the code of social law, clinical social medicine in health care according to the 5(th) book of the code of social law and social medicine in clinical social medicine/participation. Higher level-of-care hospitals, as well as rehabilitation clinics, should offer sub-specialization in social medicine without interruption of employment contracts. Corresponding criteria for the regulation on further education should be formulated by the German Society of Social Medicine and Prevention (DGSMP) as the competent scientific association and presented to the committee on further education of the Federal Medical Association. This aims at strengthening social medicine in clinical care.

[Plea for a strengthening of clinical social medicine]. / Plädoyer für eine Stärkung der klinischen Sozialmedizin.

Social medicine is concerned--in the midst of a constantly changing society--with the social and economic conditions that influence health, disease and medical care. A comprehensive medical care therefore requires medical doctors who, beyond the biomedical issues, realize diseases in the context of the social needs of the individual person and systematically include these in their prevention, treatment and rehabilitation concepts.The system of social security, particularly the health care system, depends on medical doctors' expertise in helping patients for the appropriate use of services from the system of social security. According to the German professional education regulations for doctors the additional specialization in "social medicine" also includes the competence for "assessment of the nature and extent of health disorders and their classification in the framework of social security systems". This judgment is one part of the tasks of the Medical Services belonging to the various branches of the social security system. It is also provided in practice by medical doctors with competence in social medicine working in acute care facilities.

Haemoglobin adducts from aromatic amines in children in relation to area of residence and exposure to environmental tobacco smoke.

OBJECTIVE: The influence of area of residence on haemoglobin (Hb) adducts of 4-aminobiphenyl (4-ABP), o-, m-, p-toluidine and o-anisidine was investigated in children from three different-sized Bavarian cities - Munich, Augsburg and Eichstätt, with 1,300,000, 250,000 and 13,000 inhabitants, respectively--and was compared with that of exposure to environmental tobacco smoke (ETS). METHODS: Blood samples from Munich (n = 34) and Eichstätt (n = 64) were from children attending the Paediatric Clinic of the Technical University of Munich (TUM) or a practice in Eichstätt, respectively. Blood samples (n = 126) together with urine samples (n = 88) were collected from Augsburg children during school medical examination. Personal data including possible sources of ETS exposure were obtained at the interview. Hb adduct levels were analysed by a gas chromatographic method, using mass spectrometry with selected-ion monitoring. Urinary cotinine was determined by radioimmunoassay. RESULTS: 4-ABP Hb adduct levels in children from Munich were 1.5 and 1.2 times higher than those in children from Eichstätt and Augsburg (P < 0.001). Children from Munich also had significantly higher Hb adduct levels of monocyclic aromatic amines than did children from Eichstätt and, except for o-toluidine, children from Augsburg (P < 0.005). Compared with children from Eichstätt, children from Augsburg had higher Hb adduct levels of 4-ABP, o- and m-toluidine (P < 0.01) but not p-toluidine and o-anisidine. In a multivariate analysis, gender, age and body mass index had no consistent influence on Hb adducts. ETS exposure resulted in a slight, nonsignificant increase in 4-ABP Hb adduct levels. In contrast, adduct levels from monocyclic aromatic amines were consistently decreased in ETS-exposed children (significant for o- and m-toluidine, P<0.05). CONCLUSIONS: Hb adducts from aromatic amines in children were strongly influenced by site of residence, whereas ETS exposure did not significantly increase the adduct levels.JECT

[Reality and social interpretation of health]. / Realität und gesellschaftliche Interpretation von Gesundheit.

The health profile of a human society depends upon its social development and in particular upon current social and cultural conditions. Health can be defined in many ways; both the pathogenetic and the salutogenetic approaches have their merits. Partial aspects of reality are offered for example by attempts to describe health conditions quantitatively by means of health indicators such als life expectancy, mortality, morbidity, incapacity to work, use made of medical services, and the like. The description of health must encompass the entire range of its objective and subjective experience in its somatic, mental and social dimensions. Epidemiological data must always be supplemented by the results of phenomenological observations to obtain a true picture of the experience of reality and the acceptance of the results by the group under observation.