"Debordering" public health: the changing patterns of health border in modern Europe.

According to David Fidler, the governance of infectious diseases evolved from the mid-nineteenth to the twenty-first century as a series of institutional arrangements: the International Sanitary Regulations (non-interference and disease control at borders), the World Health Organization vertical programs (malaria and smallpox eradication campaigns), and a post-Westphalian regime standing beyond state-centrism and national interest. But can international public health be reduced to such a Westphalian image? We scrutinize three strategies that brought health borders into prominence: pre-empting weak states (eastern Mediterranean in the nineteenth century); preventing the spread of disease through nation-building (Macedonian public health system in the 1920s); and debordering the fight against epidemics (1920-1921 Russian-Polish war and the Warsaw 1922 Sanitary Conference).

Debordering public health: the changing patterns of health border in modern Europe / Tirando as fronteiras da saúde pública: mudanças nos padrões de fronteira sanitária na Europa moderna

Abstract According to David Fidler, the governance of infectious diseases evolved from the mid-nineteenth to the twenty-first century as a series of institutional arrangements: the International Sanitary Regulations (non-interference and disease control at borders), the World Health Organization vertical programs (malaria and smallpox eradication campaigns), and a post-Westphalian regime standing beyond state-centrism and national interest. But can international public health be reduced to such a Westphalian image? We scrutinize three strategies that brought health borders into prominence: pre-empting weak states (eastern Mediterranean in the nineteenth century); preventing the spread of disease through nation-building (Macedonian public health system in the 1920s); and debordering the fight against epidemics (1920-1921 Russian-Polish war and the Warsaw 1922 Sanitary Conference).

Resumo Segundo David Fidler, a gestão de doenças infecciosas entre meados do século XIX e e o XXI guiou-se por uma série de acordos institucionais: Regulamento Sanitário Internacional (não interferência e controle de doenças em fronteiras), programas verticais da OMS (campanhas de erradicação da malária e varíola), e posicionamento pós-vestefaliano além do estado-centrismo e interesse nacional. Mas pode a saúde pública internacional ser reduzida à tal imagem vestefaliana? Examinamos três estratégias que destacaram as fronteiras sanitárias: prevenção em estados vulneráveis (Mediterrâneo oriental, século XIX); prevenção à disseminação de doenças via construção nacional (sistema público de saúde macedônico, anos 1920); remoção de fronteiras no combate às epidemias (guerra polaco-soviética, 1920-1921 e Conferência Sanitária de Varsóvia, 1922).

Healthcare worker compliance with seasonal and pandemic influenza vaccination.

Healthcare workers (HCWs) can be an important source of transmission of influenza to patients and family members, and their well-being is fundamental to the maintenance of healthcare services during influenza outbreaks and pandemics. Unfortunately, studies have shown consistently low levels of compliance with influenza vaccination among HCWs, a finding that became particularly pronounced during recent pandemic vaccination campaigns. Among the variables associated with vaccine acceptance in this group are demographic factors, fears and concerns over vaccine safety and efficacy, perceptions of risk and personal vulnerability, past vaccination behaviours and experience with influenza illness, as well as certain situational and organisational constructs. We report the findings of a review of the literature on these factors and highlight some important challenges in interpreting the data. In particular, we point out the need for longitudinal study designs, as well as focused research and interventions that are adapted to the most resistant HCW groups. Multi-pronged strategies are an important step forward in ensuring that future influenza vaccination campaigns, whether directed at seasonal or pandemic strains, will be successful in ensuring broad coverage among HCWs.

Influenza pandemics: past, present and future challenges.

Influenza epidemics occur regularly and prediction of their conversion to pandemics and their impact is difficult. Coordination of efforts on a global scale to control or reduce the impact is fraught with potential for under and overreaction. In light of the 1956 pandemic and more recently the SARS and H1N1 pandemics, the public health community took steps toward strengthening global surveillance and a coordinated response in keeping with the continuing memory of the tragedy seen in 1918. The scientific, professional, and technical resources of the 21st century are now advanced far beyond those then available. The H1N1 pandemic which commenced in 2009 progressed differently than predicted; its course was difficult to predict with any degree of certainty. Public responses to national immunization programs against the H1N1 virus have been weak. International movement of diseases can lead to creation of new endemic areas and continuous spread such as that which happened with West Nile Fever and Chikungunya. The lessons learned and the public and political responses to each actual or threatened pandemic will serve public health well in dealing with future challenges.

The doers of good. Scandinavian historians revise the social history of eugenics(1997-2001).

Late disclosure of the large scale of sterilization practices in the Nordic countries created an outburst of scandal: did these policies rely on coercion? To what extent? Who in the end was responsible? Sterilization practices targeted underprivileged people first. The mentally retarded and women were their first victims. Operations were very frequently determined by other people's manipulative or coercive influences. Should the blame be put on the Social-Democrats in power throughout the period (except in Finland and Estonia)? Apart from Denmark, perhaps, local physicians and local services, more than governments, seemed to have strongly supported sterilization practices. Teetotalers and feminists shared responsibilities. How can one explain that eugenics finally declined? Based on a sound application of the Hardy-Weinberg law, the science of the eugenicists was correct. Was it politics? But uncovering of the Nazi crimes had only a very small impact on eugenics. Some authors underline the fact that the Nordic scientific institutions were particularly suited to liberal values. Others point to the devastating effect on eugenics once hereditarist psychiatry fell from favor in the middle of the sixties.

[1918 lurks in everybody's mind. The "Spanish" flu and us]. / Comme en 1918 ! La grippe "Espagnole" et nous.

The 1918 pandemic is still unique in the history of flu pandemics. The pathogenicity of the virus was extreme, and young adults more than infants and old people were its main victims. Many a death was caused by complications. The response of the French authorities didn't live up to the emergency requirements. Hospitals being requisitioned by the military, the civilian population lacked everything: beds, doctors, nurses, ambulances, drugs. For want of preventive or curative medicine, authorities could have done very little at any rate: public health measures (quarantine and isolation of the sicks) were unable to stop contagion. More than the war itself, present day historians indict the war-boosted increase in railways and sea communications between the continents and between the rear and the front. This momentous growth in transportation activities brought about a "bacterial equalization" throughout social categories and regions of the world. A most singular episode, whose historical chances to replicate within the next ten years are rather slim.

[Scandinavian eugenics: Nordic historians provide new approaches]. / Eugénique à la scandinave: le débat des historiens.

Late disclosure of the large scale of sterilization practices in the Nordic countries created an outburst of scandal: did these policies rely on coercion? To what extent? Who in the end was responsible? Sterilization practices targeted underpriviledged people first. The mentally retarded and women were their first victims. Operations were very frequently determined by other people's manipulative or coercive influences. Should the blame be put on the Social-Democrats in power throughout the period (except in Finland and Estonia)? Apart from Denmark, perhaps, local physicians and local services, more than governments, seemed to have strongly supported sterilization practices. Teetotalers and feminists shared responsibilities. How can one explain that eugenics finally declined? Based on a sound application of the Hardy-Weinberg law, the science of the eugenicists was correct. Was it politics? But uncovering of the Nazi crimes had only a very small impact on eugenics. Some authors underline the fact that the Nordic scientific institutions were particularly suited to liberal values. Others point to the devastating effect on eugenics once hereditarist psychiatry fell from favour in the middle of the sixties.