Health; Well-Being and Wellness: an Anthropological Eco-Systemic Approach

More than two decades ago; Fritjof Capra commended - and indeed advocated - a paradigm shift in health science and care. In his book The Turning Point (1982) he talks of a major shift from the preoccupation with micro-organisms to a careful study of the `host organism and its environment'; of `significant attempts to develop a unified approach to the mind/body system' in Western medicine; of `a new holistic paradigm' (as opposed to `the old biomedical paradigm') regarding the problem of health and healing; of `a holistic and humanistic approach to primary care'; and of `a holistic therapy' as opposed to `the traditional biochemical practice of associating a physical disease with a specific physical cause'. Our concern in this article is with the paradigm shift advocated by Capra in this book and the progress that has since been made

[Photomedicine in gynecology]. / Photomedizin in der Gynäkologie.

In ancient years, knowledge about healing capacity of extracts from plants together with sunshine became evident in medicine. In our days second generation photosensitizers (they stand for plant extracts) and laser light (stands for sunshine) are ready for use in the clinic. Photomedicine recently became a selfstanding clinical area composed of photodynamic diagnosis (PDD) and photodynamic therapy (PDT) as its subdisciplines. Clinical application of photomedicine in gynaecology has been carefully prepared. By a number of experiments using in vitro and in vivo techniques a basis was developed to make possible clinical photomedical applications in gynaecology. In PDD 5-aminolevulinic acid, a stimulator for the production of cellular protoporphyrin IX, was used for the detection of tumour lesions of microscopical dimensions. Another approach in PDD called Frequency Domain Photon Migration technology makes it possible to quantify amounts of hem, water and oxygen in a given (tumour) tissue area. They are different from normal breast tissue. In PDT besides new technological components (diode lasers, light diffusers) there is specific need for new photosensitizers whose wavelength of activation is in the area of near infrared, allowing a better tissue penetration. Very recently, research results indicated that PDT does not create resistance against its own and suggest that this procedure can be used successfully even after radio- and/or chemotherapy. PDT of non-neoplastic but pathological cell proliferation such as endometriosis is very promising. One goal in gynaecology will be a reduction of the number of hysterectomies surgically performed by this minimally invasive approach.

[The combined use of photodynamic therapy with ionizing radiation on breast carcinoma cells in vitro]. / Kombinierte Anwendung der photodynamischen Therapie mit ionisierenden Strahlen bei Mammakarzinomzellen in vitro.

PURPOSE: The photodynamic therapy is a technique by which the tumor cells are selectively sensitized to destruction by light of an appropriate wavelength. The aim of this work is to analyze the biological effectiveness of photochemical reactions induced by laser light in tumor cells exposed to photosensitizers. MATERIAL AND METHODS: The toxicity of the 2 photosensitizers zinc phthalocyanine (ZnPC) and meso-tetrahydroxyphenylchlorine (m-THPC) as well as the biological effect of the combination of sensitizers with laser light were tested in vitro by means of a colony forming assay. In addition, the influence on the photodynamic reaction of a previous exposure of the tumor cells to ionizing radiation has been tested. RESULTS: For both sensitizers doses of 5 micrograms per milliliter of culture medium showed low toxicity, i.e. the survival of the treated cells exceeded 90%. For laser treatments the dose permitting 90% survival was determined to be around 10 J/cm2. With these doses, the combined application of photosensitizers and laser light proved to be very effective and resulted in a nearly complete reduction of survival. As expected, irradiation of the cells with doses of 1 and 2 Gy of X-rays reduced the survival to 66 and 47%, respectively, compared to untreated controls. Cells surviving such treatment showed no changes either in the response to treatments with photosensitizers or to combined applications of photosensitizers and laser light. CONCLUSION: The effects of photodynamic treatment by ionizing radiation seem to be additive and independent of each other. So, our preliminary results are quite encouraging and point out the need of further detailed studies in view of the intended clinical application of this new kind of a local treatment.

A shotgun marriage--community health workers and government health services. Qualitative evaluation of a community health worker project in Khayelitsha.

In 1988 the Western Cape Regional Services Council (RSC) initiated a community health worker (CHW) project in Khayelitsha in order to extend its preventive services to people in the community and promote 'community upliftment'. An evaluation of this project was undertaken in 1991 and 1992 in order to examine the potential of this local health authority-run CHW project to be an appropriate primary health care model. Qualitative research methods were used to explore the nature of the work done by the CHWs, whether they were accepted in their communities, and whether the project functioned as part of an integrated health service infrastructure in Khayelitsha. The CHWs were found to provide the basis for a potentially effective, community-responsive service. However, several structural problems mitigated against this service. Relations between the CHWs and nurses in all the formal public health services in the area were superficial and fraught with problems. There were significant differences and conflicting policies between the RSC's CHW project and other neighbouring non-government CHW projects, and these posed various threats to both the RSC and the non-government projects. One of the most serious of these differences was that the RSC project had no structures or plans for community involvement in the running of the project. Before a CHW project is initiated, several critical issues need to be carefully considered and discussed with all the relevant stakeholders. Furthermore, CHWs need to be flexible, and accountable to the communities in which they work. Before employing CHWs, formal public health authorities need to consider carefully whether they are able to meet these criteria.

[Are cephalosporins more active than penicillin G in poisoning with the deadly Amanita?]. / Sind Cephalosporine bei der Intoxikation mit Knollenblätterpilz besser wirksam als Penicillin-G?

High dose penicillin-G has been found empirically to be effective against liver cell damage in amanita mushroom poisoning. We have recently found that betalactam antibiotics inhibit eukaryotic DNA polymerase-alpha, penicillins being more active than cephalosporins, and this may explain the antagonistic effect of penicillin-G against amanitin toxicity. Preliminary experiments in liver cell cultures and in mice are summarized, as well as first clinical experience pointing to the possibility that cephalosporins may be more effective against amanita mushroom toxicity than penicillin-G.