Implications of COVID-19 Vaccine Hesitancy: Results of Online Bulletin Board Interviews

Reluctance to accept vaccination against COVID-19 poses a significant public health risk and is known to be a multi-determined phenomenon. We conducted online focus groups, or “bulletin boards,” in order to probe the nature of COVID-19 vaccine hesitancy and its implications. Participants were 94 individuals from three distinct U.S. geographical areas and represented a range of demographic and socioeconomic characteristics. Six themes emerged from the 3 day-long bulletin boards: the most trusted source of health information sought is the personal physician; information about health is nevertheless obtained from a wide variety of sources; stories about adverse side effects are especially “sticky”; government health institutions like CDC and FDA are not trusted; most respondents engaged in individualistic reasoning; and there is a wide spectrum of attitudes toward vaccination.

Diary notes of Matthias Stoius in “Almanach Novum” (1552–1562)

Prague Nostitz Library hides among its 14 000 books 60 volumes from the library fragment once belonging to Matthias Stoius Jr (1526–1583), the personal physician of the first Duke of Prussia Albert of Hohenzollern. The most interesting volume from the Stoius’s heritage is a copy of an astronomical calendar Almanach novum by Pietro Pitati used by Stoius as a diary containing his handwritten notes and comments about weather, income, his activity at the Königsberg University and, the most importantly, his medical records concerning the health condition and problems of his noble patient Albert of Hohenzollern. Stoius also took detailed notes about medicaments he delivered to the ill Duke as well as about treatments he applied especially in November 1559 and December 1560 when the physical condition of the duke of Prussia apparently worsened. In 1572, Stoius published in print his report about the last days of Duke Albert and although the handwritten sources on which the report is based are missing they were presumably recorded in the similar diaries.

The contribution of the Scottish doctor Robert Erskine to the development of Russian medicine in the 18th century

The Scottish doctor Robert Erskine (1677–1718) became Chief Doctor of Russia and personal physician to Tsar Peter the Great. Extensive archival material documents his remarkable career. From schooling in the village of Alva and apprenticeship to an Edinburgh apothecary, he went on to study medicine in Paris and Utrecht and was admitted to the Royal Society in London. Recruited into the service of the Tsar, to whom he became a trusted friend and counsellor, Erskine played a central role in the modernisation of Russian medicine, pharmacy and natural science in the early 18th century. His untimely death at age 41 was marked with a state funeral in St Petersburg. Some historians in Russia assert that in their country, the development of medicine and the natural sciences took place without the transitional stages of iatrochemistry and iatrophysics which characterised the shift in scientific thinking throughout Europe in the early modern period. This study of archival records shows that Erskine held iatrophysical and iatrochemical views in common with his European contemporaries. His influence ensured that Russia was thoroughly involved in European developments in science and medicine in the 18th century.

Berlin Congress 1878 Through the Eyes of Phanariot Alexander Karateodori Pashi

The article contributes to the historical literature on the Berlin Congress; it shows the events of the summer of 1878 through the eyes of the diplomats of the defeated Otto man Empire. The primary source for the article is the “Rapport” by the head of the Turkish delegation to the Сongress, Alexander Karathéodori Pasha (1833–1906), a Phanariote with Greek and Bulgarian roots, the son of the personal physician of Sultan Mahmud II and the first Ottoman lawyer. He graduated from the Sorbonne law faculty with a doctorate in law. Until recently, Turkish historians wrote about him more as a diplomat. However, in recent years, they started to pay attention to his extraordinary fate, the history of his family, in which there were many famous Phanariots. “Rapport” only in recent years began to attract the at tention of historians. The history of its creation is still unclear. It contains fascinating details of the relationship between representatives of a collective Europe at that time, the nature of their interests, and factors that outlined the fate of the Balkan region for decades to come. The report was written by Ottoman dignitaries when the Balkans finally became a “border area.” Its author noticed how the “big players” ’s geopolitical contradictions pushed the local people’s historical evolution along the “path” of future cataclysms. Alexander Karathéodori Pasha conveys, through seemingly minor details, the discord between the representatives of the “collective West” “and their desire to stop the attempts of the Ottoman Empire to follow the European paradigm of development. Against the background of the events in Berlin, Karathéodori eased the participants’ desires to start the quickest part of the “Ottoman inheritance” and drew attention to the beginning process of restructuring of international relations. He viewed the Berlin Congress analytically and realized its long-term implications.

Does a policy that requires adherence to a regular primary care physician improve the actual adherence of patients?

Background Continuity of care by the same personal physician is a key factor in an effective and efficient health care system. Studies that support the association between high adherence and better outcomes were done in settings where allocation to the same physician was a long-term policy. Objectives To evaluate the influence that changing organizational policy from the free choice of a primary care physician to a mandatory continuity of care by the same physician has on adherence to a personal physician. Methods A cross-sectional study based on electronic databases; comparison of adherence and demographic characteristics (sex, age, and socio-economic status) of 208,286 Leumit enrollees who met the inclusion criteria, according to change in the adherence to a personal physician. To evaluate adherence, we used the Usual Provider of Care (UPC) index, which measures the number of visits made to the personal doctor out of the total primary care physician visits over the same period. The patients were divided into groups according to their UPC level. Results The data shows that 54.5% of the patients were high adherers even before the organizational change; these rates are similar to those published by various organizations worldwide, years after mandating continuity of care by the same physician. In the year following the intervention, only 34.5% of the patients changed the level of their adherence group. Of these, 64% made a shift to a higher adherence group. Before the intervention, the high adherers were older (mean age 57.8 vs. 49.3 years in the low adherers group) and from a higher SES (mean SES status 9.32 vs. 8.71). After the intervention, a higher proportion of older patients and patients from a higher SES changed their adherence to a higher group. Sex distribution was similar over all the adherence level groups and did not change after the intervention. Conclusions and policy implications A policy change that encouraged adherence to an allocated primary care physician managed to improve adherence only in specific groups. Health organizations need to examine the potential for change and the groups they want to influence and direct their investment wisely. Trial registration retrospectively registered.

REASONS FOR CHANGE OF GENERAL PRACTITIONER - STUDY AMONG PATIENTS

The health reform carried out in our country has resulted in a number of both positive and undesirable results in outpatient medical care, which requires an increase in the level of public health in the country. The introduction of free choice of GPs in our country made it possible for his patients to change freely. The purpose of this study is to analyze the patient's motives for changing P. Material/methods: A survey was conducted among respondents in the period 1-30 September 2018 in the Pleven region. Patients visited their GPs during the study period. A direct individual anonymous survey was conducted containing 35 questions, of which 29 closed questions, 4 semi-open and 2 open-ended questions. The results were processed through Microsoft Office Excel 2007. Results: The analysis of a number of authors, as well as our own empirical research, show the existence of a number of motives for changing the choice of patients for a personal physician. The patient's prior knowledge of the qualities and competencies of the chosen physician is very low. This choice of patients is most often spontaneous, random and not sufficiently substantiated with specific information. In any case, this reduces the effectiveness of the free choice of doctor. Conclusions: It is necessary to improve the organization of admission of patients by GPs.

On the Threshold of Scientific Medicine: Gerard van Swieten and His Perception of the Pathophysiology in Traumatic Brain Injury

Gerard van Swieten (1700–1772), famous pupil of Professor Herman Boerhaave (1668–1738) of Leiden University and personal physician of Austrian Habsburg Empress Maria Theresa (1717–1780). Herman Boerhaave was a renowned Dutch physician inside and outside Europe in the 18th century. He was not only appointed professor in medicine, chemistry, and botany but also a chancellor of the Leiden University in 1714 and published his well-known <i>Aphorismi de cognoscendis et curandis morbis</i> in 1709. Gerard van Swieten commented upon Boerhaave’s aphorisms and demonstrated actual knowledge, less well-known among the medical community, about the pathophysiology of traumatic brain injury which half a century later (19th century) became known as the Monro-Kellie doctrine. Using the original commentaries upon Boerhaave’s aphorisms by van Swieten himself, we explored his way of formulating the pathophysiological concept of traumatic brain injury, which still is valid today.

Dissatisfaction with family members’ medical care: the relationship with trust in personal physicians and physicians generally in Japan

Negative experiences with medical care have long-term effects on family members’ attitudes and emotions. However, the impact of family members’ experiences on patients’ trust in their physicians and in physicians generally is poorly understood. We aimed to quantify these associations. Our cross-sectional online survey, conducted in Japan during April 2020, involved adults with non-communicable diseases (cardiac disease, diabetes, cancer, depression, and rheumatic disease). The main exposure variable was dissatisfaction with the medical care that family members had received. The main outcomes were patients’ (N=661) trust in their personal physicians and in physicians generally. The study adopted the Japanese version of the Abbreviated Wake Forest Physician Trust Scales. We translated and validated both 5-item scales (general and individual physician trust) for the study. The results showed a lower rating for trust in physicians generally compared to trust in the respondent’s personal physician. Furthermore, dissatisfaction with a family member’s medical care was associated with lower trust in physicians generally. Interestingly, dissatisfaction with a family member’s care was also associated with lower trust in the respondent’s personal physician, but the magnitude of this association was weaker. The lower trust in personal physicians may be mediated by reduced trust in physicians generally. We suggest that physicians enquire about past patients’ negative experiences, including dissatisfaction with family members’ medical care, to repair hidden loss of trust, when they sense that patients doubt them or physicians generally.

The gastric disease of Napoleon Bonaparte: brief report for the bicentenary of Napoleon’s death on St. Helena in 1821

After the defeat at the battle of Waterloo on June 18, 1815, Napoleon Bonaparte was sent into exile to the Island of St. Helena where he died 6 years later on May 5, 1821. One day after his death, Napoleon’s personal physician, Dr. Francesco Antommarchi, performed the autopsy in the presence of Napoleon’s exile companions and the British medical doctors. Two hundred years later, mysteries still surround the cause of his death and different hypotheses have been postulated in the medical and historical literature. The main reasons seem to be the presence of several autopsy reports, their interpretation and perhaps the greed for thrill and mystery. Therefore, for the bicentenary of Napoleon’s death, an international consortium of gastrointestinal pathologists assembled to analyse Napoleon’s autopsy reports based on the level of medical evidence and to investigate if the autopsy reports really do not allow a final statement.