Effect of prolonged fasting on plasma lipids, lipoproteins and apolipoprotein B in 12 physicians participating in a hunger strike: an observational study.
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BACKGROUND: Dyslipidemia and obesity serve as risk factors for the development of atherosclerotic cardiovascular disease. Fasting is sometimes recommended for treating these conditions. This study was undertaken to try to resolve conflicting results reported in the literature. OBJECTIVES: To study the effect of fasting (0 calories, with free intake of fluids) for 3-5 days on plasma concentration of triglyceride, cholesterol and apolipoprotein B. METHODS: Physicians, about to begin a hunger strike, were divided into four groups: normolipidemic non-obese men (group 1), two moderately obese men and two men with type IV hyperlipidemia (group 2), healthy non-obese women (group 3), and healthy non-obese women on oral contraceptives (group 4). Adherence to fasting was monitored daily by detailed interviews, loss of weight, drop in plasma glucose, presence of ketonuria, progressive rise in serum creatinine and uric acid, and decrease in plasma pH. We monitored their serum glucose, electrolytes, liver function, lipids, lipoproteins and apolipoprotein B on days 0, 3, and 5. RESULTS: Physicians who adhered to complete fasting lost more than 1.5% of their body weight after 3 days of fasting (n = 12), and more than 3.2% at 5 days (n = 5). All non-obese normolipidemic males and females (groups 1 and 3) showed an increase in plasma triglyceride (by 28-162%) and very low density lipoprotein cholesterol (by 22-316%) after 3 days of fasting. The obese and hyperlipidemic men (group 2) showed a decrease of 17-63% in their VLDL cholesterol, and the women on oral contraceptives (group 4) showed a 20% decrease in their plasma triglyceride on day 3. Low density lipoprotein cholesterol increased by 13% in group 2, decreased by 7.3% in group 4, and remained unchanged in group 1 and 3. Apolipoprotein B level correlated well with LDL cholesterol in all groups. High density lipoprotein cholesterol changes were inconsistent. CONCLUSIONS: These results help to explain and reconcile previous published reports. The metabolic background of the individual together with the amount of energy consumed affect the behavior of plasma lipids and lipoproteins levels during fasting. (+info)
Sri Lankan health care provision and medical education: a discussion.
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My elective was spent at a teaching hospital in Galle, in Sri Lanka. My time was spent shadowing final year students in the specialties of general medicine and paediatrics. This period provided me with much food for thought in comparing and contrasting the health service in Sri Lanka with that of the UK and also considering the differences in the style of medical education. In addition, during my stay, I was able to gain some appreciation of the political and organisational problems faced by a country in the midst of a civil war. In this report, I have attempted to integrate an account of my observations with a discussion of the thoughts and emotions that I experienced while working in a developing country. Studying in Sri Lanka facilitated my appreciation of facets of British health care and medical education that I had not previously considered. However, fewer resources do not necessarily mean poorer patient care: could Britain have something to learn from the Sri Lankan Health Service? (+info)
The implications of starvation induced psychological changes for the ethical treatment of hunger strikers.
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OBJECTIVE: To evaluate existing ethical guidelines for the treatment of hunger strikers in light of findings on psychological changes that accompany the cessation of food intake. DESIGN: Electronic databases were searched for (a) editorials and ethical proclamations on hunger strikers and their treatment; (b) studies of voluntary and involuntary starvation, and (c) legal cases pertaining to hunger striking. Additional studies were gathered in a snowball fashion from the published material cited in these databases. Material was included if it (a) provided ethical or legal guidelines; (b) shed light on psychological changes accompanying starvation, or (c) illustrated the practice of hunger striking. Authors' observations, opinions, and conclusions were noted. CONCLUSIONS: Although the heterogeneous nature of the sources precluded statistical analysis, starvation appears to be accompanied by marked psychological changes. Some changes clearly impair competence, in which case physicians are advised to follow advance directives obtained early in the hunger strike. More problematic are increases in impulsivity and aggressivity, changes which, while not impairing competence, enhance the likelihood that patients will starve themselves to death. (+info)
Medical students' opinions on physicians' strike: cross sectional questionnaire study.
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AIM: To investigate what Zagreb Medical School students think about general physicians' strike in Croatia, which began in February 2003. METHODS: We surveyed 771 students using a specially designed anonymous self-report questionnaire. In addition to questions on demographic data (student's sex, year of studies, average grade, and whether at least one parent was a physician), the questionnaire contained 19 items divided in three subscales, each assessing different aspects of student opinion on the strike. The first subscale, "Support", assessed students' opinion on situations where strike was an acceptable solution (8 items, alpha=0.82). The second one was "Consequences", assessing students' opinion on possible negative consequences of physician's strike (8 items, alpha=0.77). The third subscale, "Croatia", assessed students' opinions about the social and economic status of physicians in Croatia (3 items, alpha=0.73). Items were graded on a 5-point Likert-type scale. Data were analyzed with nonparametric statistics (Mann-Whitney test, Sperman's r), and the significance level was set at p<0.05. RESULTS: Students scored high on the "Support" subscale (median=34, range=8-40, interquartile range=6;) and were undecided on the "Consequences" subscale (median=23, range=8-40, interquartile range=8), whereas on the "Croatia" subscale, their scores were low, reflecting their poor opinion on the physicians status in Croatia (median=6, range=3-15, interquartile range=4). Students in the clinical years, as well as students whose one or both parents were physicians, scored higher on the "Support" subscale and lower on the "Consequences" and "Croatia" subscales than their colleagues from preclinical years or students whose neither parent was a physician (p<0.001 for all, Mann-Whitney test). No differences were found according to the students' sex, and there was no correlation between average grades and subscale scores. CONCLUSION: Zagreb Medical School students supported the physicians' strike and were undecided on its negative consequences. They thought that physicians' status in Croatia was poor. This trend was more obvious among students in clinical years whose one or both parents were physicians. (+info)
Mortality effects of a copper smelter strike and reduced ambient sulfate particulate matter air pollution.
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BACKGROUND: Numerous studies have reported associations between fine particulate and sulfur oxide air pollution and human mortality. Yet there continues to be concern that public policy efforts to improve air quality may not produce actual improvement in human health. OBJECTIVES: This study retrospectively explored a natural experiment associated with a copper smelter strike from 15 July 1967 through the beginning of April 1968. METHODS: In the 1960s, copper smelters accounted for approximately 90% of all sulfate emissions in the four Southwest states of New Mexico, Arizona, Utah, and Nevada. Over the 8.5-month strike period, a regional improvement in visibility accompanied an approximately 60% decrease in concentrations of suspended sulfate particles. We collected monthly mortality counts for 1960-1975 and analyzed them using Poisson regression models. RESULTS: The strike-related estimated percent decrease in mortality was 2.5% (95% confidence interval, 1.1-4.0%), based on a Poisson regression model that controlled for time trends, mortality counts in bordering states, and nationwide mortality counts for influenza/pneumonia, cardiovascular, and other respiratory deaths. CONCLUSIONS: These results contribute to the growing body of evidence that ambient sulfate particulate matter and related air pollutants are adversely associated with human health and that the reduction in this pollution can result in reduced mortality. (+info)
The United Mine Workers of American and the recognition of occupational respiratory diseases, 1902-1968.
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This study examines the early efforts of the United Mine Workers of America to illuminate the problem of occupational respiratory diseases in the coal fields. The union used the hearings of the US Anthracite Coal Strike Commission of 1902-3 to draw public attention to "miners' asthma." In 1915, it began to agitate for the provision of workers' compensation benefits for victims of this disorder. Throughout the 1950s and 1960s, the union's Welfare and Retirement Fund disseminated information on advances in understanding chronic pulmonary diseases of mining. In particular, the miners' fund promoted the British conceptualization of a distinctive coal workers' pneumoconiosis. At the same time, the staff of the union health plan pressed the US Public Health Service and the Pennsylvania Department of Health to investigate the prevalence of occupational respiratory diseases among bituminous miners. Taken together, these endeavors contributed significantly to growing recognition of the severity and extent of this important public health problem and thus helped lay the foundation for the Federal Coal Mine Health and Safety Act of 1969. (+info)
Are physicians' strikes ever morally justifiable? A call for a return to tradition.
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Though physicians strike provides an opportunity to generate more knowledge about the process in which legitimacy of an organization can be restored, it meets with a great deal of resistance not only by the public but from within the medical profession. This paper critically examines the legitimacy of strike by medical doctors heretofore referred to as physicians. Though critically reflecting on strikes of physicians in general, the paper makes more emphasis on Africa where physician strikes are rampant. More importantly, the paper argues that strike implies a failure for everyone in the organization (including the strikers themselves), not only the responsible government or authority. This is because when a strike occurs, an organization/fraternity is subjected to questions, scrutiny and slander. It becomes difficult to decouple what is said, decided and done. Traditionally, all medical fraternities the world-over are committed to acting comfortably to external demands-guaranteeing the patients' lives and public health. By paying attention to external reactions, the medical fraternity adapts and learns what ought and should be done so that it is never again caught in the same messy. At the same time, the fraternity prepares itself for the future strikes. When the fraternity and those outside consider it is doing up to the external expectations, its lost legitimacy is restored. When legitimacy is restored, external pressure like once disturbed water returns to normal. (+info)
Physician resistance and the forging of public healthcare: a comparative analysis of the doctors' strikes in Canada and Belgium in the 1960s.
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Organized medicine in a number of advanced industrial countries resisted the post-war trend toward more state involvement in the funding and organisation of medical care. While there were eight doctors' strikes during the peak of reform efforts in the 1960s, two of the most prolonged and bitter struggles took place in Canada and Belgium. This comparative analysis of the two strikes highlights the philosophy, motives, and strategies of organised medicine in resisting state-led reform efforts. Although historical and institutional contexts in the two countries differed, organised medicine in Canada and Belgium thought and responded in very similar ways to the perceived threat of medical insurance reform. While the perception of who won and who lost the respective doctors' strikes differed, the ultimate impact on the trajectory of public healthcare on the medical profession was remarkably similar. In both countries, the strike would have a long-standing impact on future reform efforts, particularly efforts to reform physician remuneration in order to facilitate more effective primary healthcare. (+info)