Методичні рекомендації з виконання контрольних робіт для студентів заочної форми навчання



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8. HISTORY OF MEDICINE


The earliest type of medicine in most cultures was the use of empirical natural resources like plants (herbalism), animal parts and minerals. In all societies, including Western ones, there were also religious, ritual and magical resources. In aboriginal societies, there is a large scope of medical systems related to religious thinking, cultural experience, and natural resources. The religious ones more known are : animism (the notion of inanimate objects having spirits); spiritualism (here meaning an appeal to gods or communion with ancestor spirits); shamanism (the vesting of an individual with mystic powers); and divination (the supposed obtaining of truth by magic means). The field of medical anthropology studies the various medical systems and their interaction with society, while prehistoric medicine addresses diagnosis and treatment in prehistoric times.

The practice of medicine developed gradually in ancient Egypt, Babylonia, India, China, Greece, Persia, the Islamic world, medieval Europe and early modern period in Persia (Rhazes and Avicenna), Spain (Abulcasis and Avenzoar), Syria/Egypt (Ibn al-Nafis, 13th century), Italy (Gabriele Falloppio, 16th century), England (William Harvey, 17th century). Medicine as it is now practiced largely developed during the 19th and 20th centuries in Germany (Rudolf Virchow, Wilhelm Conrad Röntgen, Robert Koch), Austria (Karl Landsteiner, Otto Loewi), United Kingdom (Edward Jenner, Alexander Fleming, Joseph Lister, Francis Crick), New Zealand (Maurice Wilkins), Australia (Howard Floery, Frank Macfarlane Burnet), Russia (Nikolai Korotkov), United States (William Williams Keen, Harvey Cushing, William Coley, James D. Watson), Italy (Salvador Luria), Switzerland (Alexandre Yersin), Japan (Kitasato Shibasaburo), and France (Jean-Martin Charcot, Claude Bernard, Louis Pasteur, Paul Broca and others). The new "scientific" or "experimental" medicine (where results are testable and repeatable) replaced early Western traditions of medicine, based on herbalism, the Greek "four humours" and other pre-modern theories.

The Sumerian god Ningizzida was the patron of medicine. In the image he is accompanied by two gryphons. It is the oldest known image of snakes coiling around an axial rod, dating from before 2000 BCE. A similar image with two snakes coiling around a rod is called the Caduceus and, although historically inappropriate, appears in the logo/emblem of a significant number of private (rather than professional or academic) medical practices.

The focal points of development of clinical medicine shifted to the United Kingdom and the USA by the early 1900s (Canadian-born) Sir William Osler, Harvey Cushing). Possibly the major shift in medical thinking was the gradual rejection, especially during the Black Death in the 14th and 15th centuries, of what may be called the 'traditional authority' approach to science and medicine. This was the notion that because some prominent person in the past said something must be so, then that was the way it was, and anything one observed to the contrary was an anomaly (which was paralleled by a similar shift in European society in general - see Copernicus's rejection of Ptolemy's theories on astronomy). Physicians like Ibn al-Nafis and Vesalius led the way in improving upon or indeed rejecting the theories of great authorities from the past (such as Hippocrates, Galen and Avicenna), many of whose theories were in time discredited. Such new attitudes were made possible in Europe by the weakening of the Roman Catholic church's power in society, especially in the Republic of Venice.



Evidence-based medicine is a recent movement to establish the most effective algorithms of practice (ways of doing things) through the use of the scientific method and modern global information science by collating all the evidence and developing standard protocols which are then disseminated to healthcare providers. One problem with this 'best practice' approach is that it could be seen to stifle novel approaches to treatment.

Genomics and knowledge of human genetics is already having some influence on medicine, as the causative genes of most monogenic genetic disorders have now been identified, and the development of techniques in molecular biology and genetics are influencing medical practice and decision-making.

Pharmacology has developed from herbalism and many drugs are still derived from plants (atropine, ephedrine, warfarin, aspirin, digoxin, vinca alkaloids, taxol, hyoscine, etc). The modern era began with Robert Koch's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of antibiotics shortly thereafter around 1900. The first of these was arsphenamine / Salvarsan discovered by Paul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class of antibiotics was the sulfa drugs, derived by French chemists originally from azo dyes. Throughout the twentieth century, major advances in the treatment of infectious diseases were observable in (Western) societies. The medical establishment is now developing drugs targeted towards one particular disease process. Thus drugs are being developed to minimise the side effects of prescribed drugs, to treat cancer, geriatric problems, long-term problems (such as high cholesterol), chronic diseases type 2 diabetes, lifestyle and degenerative diseases such as arthritis and Alzheimer's disease.

9. RISE OF BEHAVIORISM


Partly in reaction to the subjective and introspective nature of Freudian psychodynamics, and its focus on the recollection of childhood experiences, during the early decades of the 20th century, behaviorism gained popularity as a guiding psychological theory. Founded by John B. Watson and embraced and extended by Edward Thorndike, Clark L. Hull, Edward C. Tolman, and later B.F. Skinner, behaviorism was grounded in studies of animal behavior. Behaviorists shared the view that the subject matter of psychology should be operationalized with standardized procedures which led psychology to focus on behavior, not the mind or consciousness. They doubted the validity of introspection for studying internal mental states such as feelings, sensations, beliefs, desires, and other unobservables. In "Psychology as the Behaviorist Views It" (1913), Watson argued that psychology "is a purely objective experimental branch of natural science," that "introspection forms no essential part of its methods", and that "the behaviorist recognizes no dividing line between man and brute." Skinner rejected hypothesis testing as a productive method of research, considering it to be too conducive to speculative theories that would promote useless research and stifle good research.

Behaviorism reigned as the dominant paradigm in psychology throughout the first half of the 20th century, however, the modern field of psychology is largely dominated by cognitive psychology. Linguist Noam Chomsky helped spark the cognitive revolution in psychology through his review of B. F. Skinner's Verbal Behavior, in which he challenged the behaviorist approach to the study of behavior and language dominant in the 1950s. Chomsky was highly critical of what he considered arbitrary notions of 'stimulus', 'response' and 'reinforcement' which Skinner borrowed from animal experiments in the laboratory. Chomsky argued that Skinner's notions could only be applied to complex human behavior, such as language aquisition, in a vague and superficial manner. Chomsky emphasized that research and analysis must not ignore the contribution of the child in the aquisition of language and proposed that humans are born with an natural ability to acquire language. Work most associated with psychologist Albert Bandura, who initiated and studied social learning theory, showed that children could learn aggression from a role model through observational learning, without any change in overt behavior, and so must be accounted for by internal processes.


Existential-humanist movement


Humanistic psychology was developed in the 1950s in reaction to both behaviorism and psychoanalysis, arising largely from existential philosophy and writers like Jean-Paul Sartre and Søren Kierkegaard. By using phenomenology, intersubjectivity and first-person categories, the humanistic approach seeks to get a glimpse of the whole person and not just the fragmented parts of the personality or cognitive functioning. Humanism focuses on uniquely human issues and fundamental issues of life, such as self-identity, death, aloneness, freedom, and meaning. Some of the founding theorists behind this school of thought were Abraham Maslow who formulated a hierarchy of human needs, Carl Rogers who created and developed Client-centered therapy, and Fritz Perls who helped create and develop Gestalt therapy. It became so influential as to be called the "third force" within psychology (preceded by behaviorism and psychoanalysis).

10. Physics
Physics is a science that deals with the structure of matter and the interactions between the fundamental constituents of the observable universe. In the broadest sense physics, which was long called natural philosophy (from the Greek physikos), is concerned with all aspects of nature on both the macroscopic and submicroscopic levels. Its scope of study encompasses not only the behaviour of objects under the action of given forces but also the nature and origin of gravitational, electromagnetic, and nuclear force fields. Its ultimate objective is the formulation of a few comprehensive principles that bring together and explain all such disparate phenomena.

Without the science of physics and the work of physicists, our modern ways of living would not exist. Instead of brilliant, steady electric light, we would have to read by the light of candles, oil lamps, or at best, flickering gaslight. We might have crude railroad locomotives and steamships, but we could not have the highly developed and tremendously powerful machines we do. We might have buildings several stories high, but there could be no hope of erecting an Empire State Building. We could not possibly bridge the Hudson River or the Golden Gate much less build a jet plane, talk on the telephone from New York to London, or watch a television show. The personal computer would be unimaginable.

All other natural sciences depend upon physics for the foundations of their knowledge. Physics holds this key position because it is concerned with the most fundamental aspects of matter and energy and how they interact to make the physical universe work. For example, modern physics has discovered how atoms are made up of smaller particles and how these particles interact to join atoms into molecules and larger masses of matter. Chemists use this knowledge to guide them in their work in studying all existing chemical compounds and in making new ones.

Biologists and medical men in turn use both physics and chemistry in studying living tissues and in developing new drugs and treatments. Furthermore their electrical equipment, microscopes, X rays, and many other aids and the use of radioactivity were developed originally by physicists.

Physicists have also led in bringing man to think in scientific ways. What we call the scientific method had its real beginnings some four centuries ago in many fields of knowledge. The most impressive of the early triumphs came in physics and in the application of physics to astronomy for studying the apparent and real motions of the sun, the moon, the planets, and the stars.

Galileo made the first real contribution by discovering the natural laws which govern falling bodies and the swinging of the pendulum. Then Kepler established the three laws which explain all the motions of the planets. Finally, Newton verified these results by establishing the law of gravitation, which applies invariably to all matter in the universe--as small as a grain of sand or as large as the sun.

This triumph of explaining a vast range of phenomena with a single law inspired workers in all fields of knowledge to trust scientific methods. Galileo, Kepler, and Newton also made contributions to the development of telescopes and thus gave astronomy a powerful instrument to work with.

There is no exact distinction between physics and other natural sciences because all sciences overlap. In general, however, physics deals with phenomena which pertain to all classes of matter alike or to large classes of matter as long as they remain free of chemical change.

One major subdivision of physics deals with the states of matter--solids, liquids, and gases--and with their motions. The pioneer achievements of Galileo, Kepler, and Newton dealt with solid masses of matter in motion. Such studies are a part of the subject of mechanics and belong to the subdivision of mechanics called dynamics, the study of matter in motion. This large topic includes not only the motions of stars and baseballs but also those of gyroscopes, of the water pumped by a fire engine (hydrodynamics), and of the air passing over the wings and through the jet engine of an airplane (aerodynamics).

The other great subdivision of mechanics is statics, the study of matter at rest. Statics deals with the balancing of forces with appropriate resistances to keep matter at rest. The design of buildings and of bridges are examples of problems in statics.

Other divisions of physics are based on the different kinds of energy which interact with matter. They deal with electricity and magnetism, heat, light, and sound. From these branches of physics have come clues which have revealed how atoms are constructed and how they react to various kinds of energy. This knowledge is often called the basis of modern physics. Among the many subdivisions of modern physics are electronics and nuclear physics.

Physics is closely related to engineering. A person who uses physical principles in solving everyday problems is often called an engineer. For example, electricity is one of the subdivisions of physics; one who uses the natural laws of electricity to help in designing an electric generator is an electrical engineer.


ІІ. Текст для перекладу з української мови англійською.

Кількість концепцій реформування системи охорони здоров’я (ОЗ) в Україні продовжує зростати в геометричній прогресії. Не дивно, що проблема ОЗ має непогані перспективи на обговорення в режимі телешоу на найближчі років 10–15, успішно замінивши такі суспільні жуйки, як НАТО або друга державна мова.

Громадян можна тішити сподіваннями і говорити їм те, що вони хочуть чути, експлуатуючи ностальгію за «доступною, безкоштовною і якісною медициною» з одночасним відшкодуванням моральних і матеріальних збитків за хамське ставлення в комунальних лікарнях і лікарські помилки. Лікарів, презентуючи все нові й нові концепції, можна обнадіювати статусом державного службовця і водночас орієнтувати на ринкову зарплатню північноамериканських колег.

Тимчасом медичний істеблішмент разом з вищою політичною владою, підтримуючи увесь цей гамір, займатимуться своїми справами. Керівництво медичних закладів, виконуючи завдання політиків – створювати ілюзію удаваного благополуччя в медичній сфері, будуть визначати місце на ринку підлеглим лікарям; наповнювати ринок новими штатними бюджетними одиницями; самі собі визначати завдання і проблеми з метою отримання додаткових бюджетних асигнувань; шукати меценатів і спонсорів для вирішення «стратегічних державних» завдань, експлуатуючи образ подвижників, який їм створила держава.

Історія українських медичних реформ. Етапи великого шляху – від інституту сімейного лікаря до неприбуткових комунальних підприємств.

Сьогодні кількість людей, готових позитивно оцінити не те що результати, а хоча б напрямки діяльності держави в медичній сфері, досить мізерна. Серед реформаторських напрямків можна виділити 5 основних: 1) Інститут сімейного лікаря; 2) “страхова медицина”; 3) лікарське самоврядування; 4) університетські клініки; 5) некомерційні комунальні підприємства.



Інститут сімейного лікаря

Інститут сімейного лікаря може бути створений або ринком за кошти громадян, або державою за кошти бюджету. Ідея створити лікаря, який поєднає в собі кількох спеціалістів і зможе виконувати великий обсяг роботи за невеликі гроші, «чомусь» не вдалася. Треба сказати, що жоден із новостворених медичних університетів так і не наважився скористатися самоврядними повноваженнями й оголосити набір на навчання за спеціальністю «сімейна медицина», мабуть, передбачаючи «неабиякий» інтерес абітурієнтів.

Державі, щоб підготувати таких фахівців у запланованій кількості й забезпечити їх матеріально-технічними ресурсами, треба витратити не один річний бюджет країни. До того ж держава уже давно дезорієнтувалася в часі і просторі, наївно сподіваючись, що вона здатна навчити молодого фахівця бодай азів хірургії, акушерства, кардіології, неврології та ін. Ринок, який створений у «бюджетно-соціальній медицині», цього ніколи не допустить.

Сама ідея «сімейної медицини» має право на життя, як і будь-яка інша ідея, але треба врахувати таке: інститут сімейного лікаря загалом не є якоюсь уніфікованою моделлю для тих держав, у яких він є. В одних країнах цей інститут існує в системі координат державного сектору, в інших – у приватному секторі, і в обох випадках він не є предметом уваги політичної влади. Є країни, де сімейний лікар – це не місце першого працевлаштування молодого фахівця, а якщо так, то термін інтернатури значно довший, ніж з інших спеціальностей. Кожне суспільство має свій, відповідний до його ментальності, економічного розвитку і запиту, інститут сімейного лікаря.



Наш інститут сімейного лікаря – це продукт вітчизняних кабінетних мудреців, далеких від медичної практики та соціології, але зате дуже близьких до бюджетних коштів, така собі імітація діяльності.
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