Missions of a medical school: a European perspective.

A medical school should be active in various realms, which can be mentioned in a mission statement. Undergraduate training should be situated in the context of medical training as a whole, which does not stop with graduation. Rapid sociocultural change and scientific progress call for production of a "multipotential" graduate, educated at a high scientific standard to keep up with biomedical progress and motivated for continuing education. The graduate should have sound ethical preparation and strong communication skills. In all countries, university hospitals and teaching hospitals should at least contribute to postgraduate specialty training and continuing education. Scientific research must be a fundamental activity of a medical school. Tasks of a faculty include obtaining research funding, solving problems young clinicians face in doing research, and attending to the scientific integrity of researchers. A medical faculty must evaluate itself. Factors in health improvement include appropriate lifestyles and social behaviors; a medical faculty should educate the population in this regard. The faculty should also participate in advising local health administrators, for example by helping to predict the needs of the population and the development of medical care. International cooperation, including joint activities and exchange of information on approaches to problems, can help improve performance in all the areas noted above.

["Heart transplantation program" in Piedmont. Results of a 3-year activity]. / "Programma trapianto di cuore" della Regione Piemonte. Risultati dopo tre anni di attività.

Since 1990 the "Heart Transplant Program" has been instituted in the Piemonte Region. Until now the program had regular development according to the number of transplantations and the high quality of clinical results. Sixty heart transplantations has been performed with a 36 month survival close to 80%. Our data demonstrate that after heart transplantation prognosis of end-stage cardiac disease is highly improved either for life expectancy and for quality of life. Our program includes several aspects of scientific research from physiology to clinic, from biochemistry to immunology, from infectivology to pathology, from intensive care to surgery. Several very positive multi disciplinary investigations have been activated.

Genetic, immunologic, and environmental heterogeneity of IDDM. Incidence and 12-mo follow-up of an Italian population.

The 1-yr incidence of insulin-dependent diabetes mellitus (IDDM) in a population of the Piedmont and Aosta Valley area of Italy was recorded. Anti-virus antibodies (e.g., Coxsackie B1-6, mumps, cytomegalovirus), islet cell antibodies (ICAs), and HLA-A, -B, -C, and -DR were determined in 74 IDDM patients (38 males, 36 females) and in controls. Total IDDM incidence was 5.0/100,000, and the incidence for those less than 20 yr of age was 11.6/100,000. Anti-virus antibody frequency was not different in IDDM patients and controls. ICAs were present in 58% of IDDM patients at onset and in 30% after 12 mo, and complement-fixing ICAs were found in 39 and 17%, respectively. IDDM was significantly and positively associated with DR3/DR4 and negatively associated with DR2 and DR5. ICA frequency was significantly higher in DR3/DR4 heterozygote patients than in patients without DR3 and DR4. These results suggest that in this IDDM population viral etiology is not evident, ICAs offer only a partial pathogenetic explanation, and genetic and immunologic heterogeneity is evident.