Brocher Foundation

Genetic knowledge of disease risk may induce a sense of genetic responsibility whereby those who are at risk feel an obligation to take certain actions not only in relation to their own personal health but also to their family, their children and many other aspects of their life. This article examines genetic responsibility among Ashkenazi Jewish women at increased risk of BRCA genetic breast cancer. It demonstrates the ways in which accounts of blame help to mitigate or allocate genetic responsibility and in particular focuses on the temporal nature of women's accounts. Women locate responsibility or blame for genetic disease in the collective reproductive history of Ashkenazi Jews, currently among specific groups of Ashkenazi Jews, and this knowledge can have potential future reproductive consequences. A contradiction may arise between a pre-existing sense of responsibility to produce future generations of Jews with that of producing future breast cancer free children. The research is based on in-depth qualitative interviews with 14 high-risk Ashkenazi Jewish women in London, England.

An integrated model of care has been used effectively to manage chronic diseases; however, there is limited, yet encouraging evidence on its introduction in the management of inflammatory bowel disease (IBD), a chronic gastrointestinal condition. Here, the rationale for and implications of introducing an integrated model of care for patients with IBD are discussed, with a particular focus on psychology input, patient-centred care, efficiency as perceived by patients and doctors, financial implications and the possible means of model introduction. This is a discussion paper on the integrated model of care for IBD against a background of what has been learned from an integrated model of care established in other chronic conditions. Although limited, the emerging data on an integrated model of care in IBD are encouraging with respect to patient outcomes and savings in healthcare costs. In other conditions, the model has been well received by both patients and practitioners, although the loss of autonomy by doctors is listed among its drawbacks. The cost-effectiveness data are now sufficiently convincing to recommend the model's acceptance in principle. The model should be promoted at the policy level rather than by individual practitioners to facilitate equal access for patients with IBD on a larger scale than currently.

\n\t\t\t\t\tRecommendations from the 3rd round of the Report of the results for the national clinical audit of adult inflammatory bowel disease (IBD) inpatient care in the UK published earlier this year by UK's Royal College of Physicians and mentioned in the Lancet in March 20121 report improvements in the quality of care (QoC) of patients with IBD since audits began in 2006 but also list improvements yet to be achieved. Importantly, optimising the quality of life (QoL) of sufferers was indicated as deserving greater attention as part of the global approach to improved QoC.\n\t\t\t\t

Between 1817 and 1821, the Indian subcontinent was devastated by a series of cholera outbreaks that have subsequently been referred to as the beginning of the First Cholera Pandemic. Although the history of the First Cholera Pandemic has received some scholarly attention, historians tend to overlook the local features of the pandemic in favor of the broader colonial context. In this article, the author contends that the official response to the epidemic in Bombay city and presidency (1818-1821) was initially ameliorative, including recruiting native medical assistants to administer treatment. Such a measure was calculated to cultivate a benevolent image of the colonial government among local inhabitants. Despite considerable nosological and etiological disagreements, members of the Bombay Medical Board characterized cholera as a social disease. Unlike cholera epidemics in the latter half of the nineteenth century, the first cholera epidemic in the Bombay presidency did little to exacerbate antagonism towards the colonial government for two reasons. First, the British power in India was still at its formative stage. Second, both in India and England, cholera was associated with the derangement of bodily humors. On the contrary, the epidemic provided a stimulus to intracommunal discord. Antara tahun 1817 dan 1821, anak benua India dilanda serangkaian wabah kolera yang kemudian disebut sebagai awal dari Pandemi Kolera Pertama. Meskipun sejarah Pandemi Kolera Pertama telah mendapat perhatian ilmiah, para sejarawan cenderung mengabaikan ciri-ciri lokal dari pandemi ini dan lebih memilih konteks kolonial yang lebih luas. Dalam artikel ini, penulis berpendapat bahwa tanggapan resmi terhadap epidemi di kota dan wilayah kepresidenan Bombay (1818-1821) pada awalnya bersifat perbaikan, termasuk merekrut asisten medis pribumi untuk memberikan pengobatan. Tindakan seperti itu diperhitungkan untuk menumbuhkan citra baik pemerintah kolonial di kalangan penduduk setempat. Meskipun ada perbedaan pendapat nosologis dan etiologis, anggota Dewan Medis Bombay menggolongkan kolera sebagai penyakit sosial. Berbeda dengan epidemi kolera pada paruh kedua abad ke-19, epidemi kolera yang pertama pada masa kepresidenan Bombay tidak banyak memperburuk antagonisme terhadap pemerintah kolonial karena dua alasan. Pertama, kekuatan Inggris di India masih dalam tahap pembentukan. Kedua, baik di India maupun Inggris, kolera dikaitkan dengan gangguan humor tubuh. Sebaliknya, epidemi ini memberikan stimulus terhadap perselisihan antar masyarakat.

One of the pioneers in South Asian colonial medical history, Mridula Ramanna has provided a regional illustration of colonial medicine in the Bombay Presidency, western India, between 1850 and 1920. Extensively based on research at the Maharashtra State Archives, Mumbai (formerly Bombay), the monograph examines disparate themes in the history of health and medicine in the Bombay Presidency. These include the health of European poor in Bombay city; an analysis of the writings of nineteenth-century Bombay physicians on aspects of illness; Florence Nightingale’s views on health in Bombay Presidency; state of sanitation in towns and villages of the Presidency; pilgrimage control at Bombay and a description of the 1918 influenza pandemic. The period between 1850 and 1920 is critical to understand the emergence of public health in the context of a colonial port city. A period of rapid economic growth in Bombay city began from the 1850s that coincided with the establishment of textile mills, steam ginning, modern banks and steam shipping. The city was not only a hub for trade with Europe but also a point of departure for pilgrims going on Haj. The city acted as a magnet for entrepreneurs from Gujarat and labourers from Konkan. In view of the increasing commercial importance of the port of Bombay, there was an urgency to deal with disease. Ramanna captures the shift in disease aetiology from the then prevalent miasmatical theory in the nineteenth century that ascribed disease to exhalations from unhealthy soil to the emergence of the germ theory of disease. The city of Bombay served as a backdrop for experimental trials related to serum treatment for plague. In the last chapter, ‘Influenza Pandemic, 1918, Re-visited’, Ramanna notes that pandemic influenza in Bombay city stimulated the rise of nationalist consciousness.