The influence of geopolitical change on the well-being of a population: the Berlin Wall.
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OBJECTIVES: Social cohesion is recognized as a fundamental condition for healthy populations, but social cohesion itself arises from political unity. The history of the Berlin Wall provides a unique opportunity to examine the effects of partition on social cohesion and, by inference, on health. METHODS: This ethnographic study consisted of examination of the territory formerly occupied by the Wall, formal and informal interviews with Berlin residents, and collection of cultural documents related to the Wall. Transcripts, field notes, and documents were examined by means of a keyword-in-context analysis. RESULTS: The separation of Berlin into 2 parts was a traumatic experience for the city's residents. After partition, East and West Germany had divergent social, cultural, and political experiences and gradually grew apart. CONCLUSIONS: The demolition of the Wall--the symbol and the instrument of partition--makes possible but does not ensure the reintegration of 2 populations that were separated for 40 years. The evolution of a new common culture might be accelerated by active attempts at cultural and social exchange. (+info)
Occupational health and safety from communist to capitalist structures.
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This article focuses on individual effects of the transformation from communist to capitalist structures in the system of occupational health and safety (OHS). Despite basic similarities among the communist nations the systems of OHS differed immensely. The political changes during transformation additionally contributed to varying opportunities for the development of OHS systems. Changes affecting the living and working conditions are significant and are demonstrated by the development of new work structures and work biographies. This is reflected in changed attitudes to demands and contents of work. No differences, however, were found between the employed and unemployed when asked about these issues. Conclusions for OHS in postcommunist states are drawn. (+info)
Bulgarian population in transitional period.
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In the transition period from a communist to market-oriented economy, Bulgaria faces several public health challenges. One of them is the decline in population (estimated fall from current 8.25 million to around 6 million in 2045), mainly due to emigration and pronounced fall in fertility. Infant mortality is still relatively high (over 15/1,000 live births), and the incidence of tuberculosis is on the rise. Total mortality shows a steady upward trend from 12.1/1,000 in 1990 to 14.3/1,000 in 1998. Trends in ischemic heart disease are comparable to those in other Central and Eastern European countries, but stroke mortality is notably higher. This calls for detailed epidemiological studies of risk factors, such as salt consumption, as well as preventive programs for detection and control of high blood pressure. The problems of smoking and alcohol abuse should be addressed by a coordinated public health and legal measures. (+info)
Application of social science theories to family planning health education in the People's Republic of China.
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The transformation of the Chinese society was political and economic by revolution; it was also social and cultural through mass education. Group decisions have been used to induce social change in the Chinese society and applied extensively to the family planning program. The methods which Kurt Lewin developed to change food habits, have been perfected on a grand scale of myriad ways by the Chinese. (+info)
Screening for phenylketonuria in a totalitarian state.
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Living under a totalitarian regime has many effects on the structure, way of thinking, and relations in a society. However, it is the impact on neonatal genetic screening that we discuss in this paper. Genetic screening functions at the interface between health services and society at large. Being involved for over a decade in setting up the Bulgarian PKU screening programme, we have had to deal with ways and attitudes which may be difficult for the western mind to grasp. Yet comprehension is very much needed in the new world we are trying to create. (+info)
Management of Gaucher disease in a post-communist transitional health care system: Croatian experience.
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AIM: To evaluate the feasibility of financing the treatment of Gaucher disease with recombinant human imiglucerase in the Croatian health care system. METHODS: Treatment with enzyme replacement therapy of 5 patients with Gaucher disease was started on January 2001. In 4 patients the typical signs of Gaucher disease (organomegaly, bone changes, anemia, and thrombocytopenia) were documented at the time of diagnosis. One patient received bone marrow stem cell transplant as treatment for acute myeloid leukemia from a HLA-matching sibling with Gaucher disease. All patients underwent therapy with imiglucerase (Cerezyme) infusion every 14 days. The outcome and actual cost of the treatment were followed during 12 months. RESULTS: After 3 months of therapy, hemoglobin rose above low normal range in 2 patients. After 6 months, 3 patients had platelet count above 100x10(9)/L, and bone pain crises completely disappeared in patients with severe bone involvement. After 12 months, normal blood counts were restored in all patients. At the same time point, bone destruction remained unchanged in 3 patients and showed marked improvement in one. In agreement with the Ministry of Health, the Croatian Institute for Health Insurance restructured its funds and established a special "Fund for expensive drugs." This fund covers the treatment costs for patients with Gaucher disease (approximately 150,000 per patient per year) as well as the cost of treatment for patients with Fabry disease, AIDS, adenosine deaminase deficiency, multiple sclerosis, chronic myeloid leukemia, juvenile arthritis, and ovarian cancer. CONCLUSION: Collaboration of the institutions in a post-communist transition health care system can provide an effective model for financing expensive treatment for patients with rare diseases in a resource-poor health system. (+info)
Czechoslovakia's changing health care system.
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Before World War II, Czechoslovakia was among the most developed European countries with an excellent health care system. After the Communist coup d'etat in 1948, the country was forced to adapt its existing health care system to the Soviet model. It was planned and managed by the government, financed by general tax money, operated in a highly centralized, bureaucratic fashion, and provided service at no direct charge at the time of service. In recent years, the health care system had been deteriorating as the health of the people had also been declining. Life expectancy, infant mortality rates, and diseases of the circulatory system are higher than in Western European countries. In 1989, political changes occurred in Czechoslovakia that made health care reform possible. Now health services are being decentralized, and the ownership of hospitals is expected to be transferred to communities, municipalities, churches, charitable groups, or private entities. Almost all health leaders, including hospital directors and hospital department heads, have been replaced. Physicians will be paid according to the type and amount of work performed. Perhaps the most important reform is the establishment of an independent General Health Care Insurance Office financed directly by compulsory contributions from workers, employers, and government that will be able to negotiate with hospitals and physicians to determine payment for services. (+info)
The medical libraries of Vietnam--a service in transition.
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The medical libraries of Vietnam maintain high profiles within their institutions and are recognized by health care professionals and administrators as an important part of the health care system. Despite the multitude of problems in providing even a minimal level of medical library services, librarians, clinicians, and researchers nevertheless are determined that enhanced services be made available. Currently, services can be described as basic and unsophisticated, yet viable and surprisingly well organized. The lack of hard western currency required to buy materials and the lack of library technology will be major obstacles to improving information services. Vietnam, like many developing nations, is about to enter a period of technological upheaval, which ultimately will result in a transition from the traditional library limited by walls to a national resource that will rely increasingly on electronic access to international knowledge networks. Technology such as CD-ROM, Integrated Services Digital Network (ISDN), and satellite telecommunication networks such as Internet can provide the technical backbone to provide access to remote and widely distributed electronic databases to support the information needs of the health care community. Over the long term, access to such databases likely will be cost-effective, in contrast to the assuredly astronomical cost of building a comparable domestic print collection. The advent of new, low-cost electronic technologies probably will revolutionize health care information services in developing nations. However, for the immediate future, the medical libraries of Vietnam will require ongoing sustained support from the international community, so that minimal levels of resources will be available to support the information needs of the health care community. It is remarkable, and a credit to the determination of Vietnam's librarians that, in a country with a legacy of war, economic deprivation, and international isolation, they have somehow managed to provide a sound basic level of information services for health care professionals. (+info)