The Cultural Context of Ageing

EUROMEDS September 2013 LISBON GA EDITION

CONTENTS

NOT GETTING ANY YOUNGER .................................................................. 04 ASKING THE EXPERT: HOW TO GET OLD PROPERLY ........................................... 06 PROBLEMS RELATED TO POLYPHARMACOTHERAPY OF ELDERLY PATIENTS .... 10 ACTIVE AND HEALTHY AGEING ............................................................................ 12 PREPARING SOCIETIES FOR AN AGEING TIME-BOMB ......................................... 15

IMPRESSUM Editor in Chief OLGA ROSTKOWSKA Authors GELU ONOSE KAROLINA PACIOREK DIKE CHRISTABEL AKPENUCHI MGBACHI OKWUDILI CELESTINE FELICITY JONES NICK SCHNEIDER DAMLA YAGMUR ORKUN KOPAC ANA GEORGESCU IBUKUN ADEPOJU MATEJ BREZNAR GINTARE ZUKAUSKAITE DZIUGAS MESKELEVICIUS SOFIA RIBEIRO IDF EUROPE POLONA SAVIC JIAWEI LI Proof-Readers AMIR MOHSENPOUR DARIA GHEORGHE IBUKUN ADEPOJU NIKOS KORAKAS OLGA ROSTKOWSKA Design and Layout DIOGO MEDINA DEMIJAN ANGELKOVSKI

WHAT’S UP EMSA? ................................................................................... 18 FROM BED-SIDE TO DESK-SIDE ............................................................................ 20 THE WAY TO EXCELLENCE: EMSA TNT AND TCE ................................................. 21 I LOVE EMSA ......................................................................................................... 22 WHAT’S UP, DUCK? ............................................................................................... 26 HIV UNMASK-ED ................................................................................................... 27

ONCE UPON A TIME IN EUROPE .............................................................. 28 LET’S TALK ABOUT SEX ........................................................................................ 30 THE SCHOOL OF NEUROSCIENCES ....................................................................... 33 ATTENDING AN INTERNATIONAL HIV CONFERENCE ........................................... 36

Cover Photography TARDIA.DEVIANTART.COM Print MACEDONIA Publisher EMSA EUROPE Contacts EMSA GENERAL SECRETARIAT C/O CPME RUE GUIMARD 15 1040 BRUSSELS, BELGIUM WWW.EMSA-EUROPE.EU EMSA-EB@GOOGLEGROUPS.COM

FRIENDS. FAMILY . NEIGHBORS ................................................................... 38 HEALTHCARE PROFESSIONALS’ ROLE IN DIABETES CARE & PREVENTION ...... 40 O FORTUNA ........................................................................................................... 42 FUTURE OF AMSA-EMSA ...................................................................................... 43

Opening Word EUROMEDS IS ALSO AVAILABLE AT WWW.BLUEMIST.EU

W

ith the summer already coming to its end and the

Apart from the main theme, you will find plenty of

academic year 2013/2014 showing-up on the

information on several EMSA initiatives, among which the

horizon, we are excited to introduce you to the work of those

Training Centre of Excellence takes a great part (an annual

who sacrificed part of their holiday in order to create

training event in EMSA). See also individual projects carried

together something as an EMSA Team: EuroMeds 2013,

out in Lithuania and Slovenia. Feel free to contact the

released on the occasion of the General Assembly in Lisbon,

authors to learn more about what medical peers are up to in

Portugal.

other parts of the continent and the world — especially in

This issue revolves around the topic of ageing, especially

the article on external conferences. There is also a small

active and healthy, which has been on the mind of

treat for those who love classical music.

demographers, health-care representatives, economists and

Have a great read, share EuroMeds with your friends and

engineers for quite a while already. What does it mean that

university colleagues, and spread the ‘blue word’ far and

we’re getting older as a population? Is ‘getting older’ now

wide. We wish everyone to find something for him or herself

different than it was 20 years ago? If inevitable, how to do it

in the issue you’re just opening. Also, tell us how to do it

prudently? Turn the page to discover answers to those

better next time! You’ll find all addresses at the back.

questions and find nutrition and life-style tips you can

Last but not least, enjoy the atmosphere of the General

consider useful when defining your own way of battling the

Assembly which gathered in one place countless EMSA

obstacles posed to your body, mind and general well-being

enthusiasts and followers without whom this magazine

over time. If not for yourself, see what’s in it for your family

wouldn’t exist. 

or your patients (regardless of the specialty, you will see more and more elderly in your practice). It’s never too early

BORISLAV MANEV

to start taking care of your diet or physical activity and never

2011/2013 President of EMSA Europe

too late to fight habits that can leave a stain on a healthy lifestyle. Once somebody wisely said that none of us are

OLGA ROSTKOWSKA

getting any younger, whereas in EMSA we say: take control

EMSA Officer in Brussels & EuroMeds Editor-in-Chief

of that process!

This issue revolves around the topic of ageing, especially active and healthy, which has been on the mind of demographers, health-care representatives, economists & engineers for quite a while already

asking the expert: How to Get Old Properly?

Professor Gelu Onose (MD PhD) is a Senior Physician in Physical & Rehabilitation Medicine (PRM) and Gerontology & Geriatrics, President of the Romanian Society for Neurorehabilitation (RoSNeRa), a Senior Expert within the Active and Healthy Ageing Working Group, and Rapporteur on chronic conditions management of the Standing Committee of the European Doctors (CPME).

He is the author of over 200 papers, 8 scientific books, chapters of medical books and 3 patents, as well as recipient of several awards, including Gold Medal at the 2008 International Saloon of Inventions in Geneve, Switzerland.

Jacques van der Vliet (The Netherlands)

related augmented costs) and on the other, the lowering of

Within the elderly we see declining functional capacity and

the quality of life (QOL) for such individuals, particularly

increasing chronic conditions and even polimorbidities and

because as the older becomes a person, usually he/she has

polipharmacies. Of course interventions by doctors and

to face — quantitatively and regarding severity, too — a

other carers are important here, but the main challenge lies

growing

in the necessity of changing habits and behaviour of people

secondary (poli-)disabilities. Moreover, as the mean life

in earlier stages of their lives. How do you see that we can

duration extends, the balance between active (contributors/

influence and change behaviour in society? Some say: we

taxpayers) and passive (retired/ pensioners) people tends to

have to start in schools, at the very early start of going to

incline in favor of the latter, resulting in threatening

“kindergarten” even.

reduction,

Professor Gelu Onose

sustainability; therefore, a ”reflex” of any government facing

The process of ”demographic ageing” in an alert rhythm -

such a situation is to extend the age limit for retirement:

especially, but not exclusively, in many developed countries -

including in the European Union this trend appeared,

is both: an obvious reality (proven, including statistically, by

probably towards reaching, on medium-term, almost (or

scientific studies) and a consequent major challenge, at

even) the age of 70 years. But lengthening the duration of

global level, of this of Millennium’s debut. It suffices to

active life entails, additionally, a more complicated matter: a

mention, in this respect, on one hand, the enhanced bio-

person close to the age of retiring frequently/ normally is at

medical and economic burden for society, represented by

the culmination of his/her career (possibly having a leading

the (quite fast) growing, in number and as percentage, of the

professional position, too); thereby, the requirements from

elderly within the general population (thus resulting,

the part of his/her job are higher, whereas the respective

accordingly, in greater needs for medical interventions, with

order’s employee are — naturally — declining; to overcome

6 { EUROMEDS September 2013

functional

of

decline

different

and

national

polipathology,

pension

with

schemes’,

such a possible divergent/ conflicting situation, maintaining

individual state of the cardio-vascular apparatus and related

in a good state of health — psychological/ cognitive and

endurance — which, based, in principal, on an appropriate/

physical

—

and

functionality

(including

as

social

improved blood supply, provides protection also for the age-

participation), is mandatory. Considering all these, keeping

progressively/ para-physiological cognitive decline), no

all the age categories of people and particularly — in the

smoking and no alcohol abuse (but not complete avoidance

context of the afore evoked alert demographic ageing

of the latter — as encompassed in the Mediterranean diet:

process — the elderly, as healthy and furthermore, as fit as

generally, a glass of red wine daily is considered to have

possible (thus minimizing the so-called tear/ acquired —

some anti-ageing effects — this is a longer discussion,

metabolically related — dimension of ageing) represents,

exceeding the editorial space that can be reasonably

including an emblematic example of happy merging of

allocated to an interview — are habits and behaviors that

individual with community interests. In this respect, coming

seem to provide including some natural gero- ”prophylaxis”.

specifically to your question: yes it is necessary to raise

The earlier, throughout life, understood and individually

awareness of people on the importance/ necessity of

implemented such elementary principles and related

learning — or changing to — a lifestyle with healthy habits

personal endeavors, most probably the better; yet, a good

and behaviors. Hence, it is to be underlined the strategic

news is that even if adopted later, for instance at middle-

attention, in this regard, of the European Commission, that

age, healthy habits and behaviors still seem to exert some

considers "Frailty in old age, a public health concern at EU

anti-(metabolically related) ageing/ gero-”prophylactic”

level" and accordingly, supports the European Innovation

effects.

Partnership on Active and Healthy Ageing” (EIP-AHA) — with the involvement of members of the Action Group on

Olga Rostkowska (Poland)

Frailty and Functional Decline and respectively, of the

If you were to pick one specific factor which could make us

I2FRESCO project, on integrated interventions for frailty

’age more healthily’, what would it be? Even though

prevention in older people/ patients (the CPME being,

probably it is a larger set of small factors, maybe there is an

including in this field, very contributive, specifically by the

outstanding one?

sustained activity of its Working Group on Active and Healthy

Professor Gelu Onose

Ageing) — and its remarkably humanistic and ambitious, as

For the sake of a straight answer to the specific design of

well, specific objective: to enhance, by 2020, with 2 years,

your question, I could chose: a pro-active lifestyle, but

the average Healthy Life Years at birth for the EU citizens all

otherwise — because, as it is said, for good reason: a

confirm the importance of this complex subject matter.

system is more than just the sum of its component parts — I

Basically, to our present knowledge and practical expertise

recommend the association of the all four above exposed

in the domain, a balanced and non-aggressive (mainly for

items of healthy habits and behaviors.

the digestive and metabolic functions — of ”Mediterranean” kind, for instance) nutrition, a physically/ pro-active life style

Ukte Cengiz (Turkey)

— mainly by systematically/ daily practicing of dynamic

What are the effects of drinks such as coffee or tea on health

exercises

ageing?

(methodologically

adequate

to

the

actual,

Professor Gelu Onose Regarding coffee (and)/or tea: these drinks have been (empirically but still convincingly) validated, first of all by the very — especially for tea — long time since they are consumed, meaning, last but not least, a very large acceptability because of their agreeable taste, which is for 

EUROMEDS September 2013 } 7

that matter, part of the quality of life (QOL); thus, as long as

Olga Rostkowska (Poland)

a nutritional item does not prove, on long term, to obviously

What can medical students and young health-care

cause definite disturbances/ diseases/ conditions, but

professionals do to become excellent advocates of Healthy

instead contributes to the QOL, it can be reasonably

and Active Ageing?

considered to belong/ contribute to healthy life style/ habits

Professor Gelu Onose

and behaviors. As for the scientific basis/ mechanisms of

Medical students and young health-care professionals, in

action, I should start by quoting the opinion of N. Lowry

order to become excellent advocates of Healthy and Active

(Professor of Chemistry, Hampshire College, Amherst, MA):

Ageing must, on one hand, be themselves, living examples of

”Tea drinking is an ancient art, scientific research on it is

real adherence to the four items of healthy habits and

young yet”. The main active substance contained in coffee

behaviors, previously presented and on the other, ask their

and tea (without entering a longer discussion on different

responsible for curricular development, to provide adequate

types of related plants from which these two drinks — and

teaching content, dedicated to the: biology of ageing,

consequent variants, especially of tea — can be prepared) is

adaptive physiology of physical exercises, nutrition and

caffeine, (together — first for tea — with the metabolites:

social gerontology; thus, empowered with solid scientific/

theophylline and theobromine and respectively, with anti-

professional/ Evidence Based Medicine (EBD) related

oxidant molecules, such as aka flavanoids polyphenols).

knowledge, they could conclusively — and thereby,

There is no need to argument the (including) anti-ageing

efficiently/ excellently — advocate in this respect.

well-known role of anti-oxidants, to be found in coffee, too.

Coming back to caffeine, different — including recent —

Ukte Cengiz (Turkey)

studies report its positive effects, of psychomotor kind,

To be aware of healthy ageing is a big step for countries like

including a dose-related action of habitual/ regular, long-

Turkey. Can we realize a health literacy program ? What are

term coffee/ caffeine consumption for preventing cognitive

the examples of implementation that already exist?

decline in elderly (including for the risk to develop

Professor Gelu Onose

Alzheimer’s Disease), especially (interestingly and subject

To be aware of healthy ageing, is a big step, I consider, for

for further clarification, why ?) in women — mainly over 80

each country, not only/ especially for Turkey. I have

years old — and also reduce the risk of stroke. Moreover,

previously emphasized that in the European Union there is a

moderate coffee consumption may mitigate the risk of

consistent and sustained concern and related actions, in

developing type 2 diabetes, probably not through caffeine

order to promote active and healthy ageing. As it is known,

but maybe by action of antioxidants. Regarding cardio-

Romania has major contributions and protochronisms in the

vascular apparatus: moderate coffee consumption does not

Geronto-Geriatrics domain, Prof. Dr Ana Aslan being one of

seem to have negative effect on it, except for high levels of it

the world leading academic personalities in this field: as of

(more than 5 cups per day), which increases blood

this medical specialty and also the founder — and its first

homocysteine levels (this having some, but not yet

Director — of the first world Institute: the National Institute

completely clarified, relationships with circulatory diseases

of Gerontology and Geriatrics, in Bucharest (at present, by

risk) and respectively, for enhancement of total and LDL

the name of Ana Aslan, in her honor) — founded in 1952 (!).

cholesterol blood concentrations (not by caffeine’s action,

Furthermore, because Romania is a country with great

but of some other contained substances — that can be

balneary/ spa resources and with one of the oldest and very

eliminated

coffee

prestigious, at international level, medical school of Balneo-

consumption may augment the risk of falls in Parkinson’s

Physiatry (including with a related National Institute - which

Disease.

originates almost 90 years ago — in Bucharest), we have

through

filtration).

Additionally,

most

8 { EUROMEDS September 2013

important

professional

skills

in

the

inter-/

multidisciplinary domain of the Balneo-/Physiatric- Geriatric

providing for the elderly should be held, under the exposed

Health Tourism, including with the well-known related: anti-

context, by the elderly themselves.

ageing, anti-stress/ fag, prophylactic active/ rest/ ”mise-enforme”, work capacity maintaining/ re-performing — cures.

Olga Rostkowska (Poland)

So, coming specifically to this question of yours: of course

When does ageing begin? Is it possible to point out this

we can make a health literacy program on this subject

concrete moment?

matter; actually, as afore emphasized, in Romania I/ we are

Professor Gelu Onose

teaching to my/ our students such items. Additionally,

As it is known, ageing is considered, at present, to have a

regarding the first part of your question: for instance, the EU

double determinism: biological and psycho-social, and within

Pre-accession Assistance Program — specifically through its

the biological one, two dimensions — genetic and

“Instrument

—

respectively, tear/ acquired, metabolically related. Under

represents an excellent frame work for developing such a

these complex circumstances and conditionings, to point out

literacy program, in which the EU member states could

a concrete moment for the onset of ageing is very difficult

collaborate with candidate countries — like Turkey — for

and maybe also, conceptually risky, especially as although

admission into the EU.

the tear/ acquired, metabolically related pro-ageing factors

for

Pre-Accession

Assistance

(IPA)”

Medical students and young health-care professionals, in order to become excellent advocates of Healthy and Active Ageing, must be themselves living examples of real adherence to healthy habits and behaviors Olga Rostkowska (Poland)

start to act practically after birth (and are largely dependent,

Who has the biggest role in providing for the elderly people:

concerning the ageing rhythm, of lifestyle habits and

doctors, family, social carers - from the public health point

behaviors, including/ mainly — but not exclusively - of diet

of view? Maybe the elderly themselves.

but also of possible pathological severe/ chronic events’

Professor Gelu Onose

kind), within the development period, i.e. of childhood and

It is difficult to choose and designate, as having ”the biggest

even of young adulthood (for instance the complete,

role in providing for the elderly people”, only one of the —

including with the bone late ”capitalization”, development of

otherwise all important — related factors you have

the skeleton), there are occurring processes, in principle

mentioned; at least from the contemporary society’s point

opposed to ageing; hence, probably around the period

of view (whithin which advocating and contributing, through

within the life cycle, of passing from young adulthood to the

specific

adulthood itself, i.e. about over 35 years old, could be a

and

effective

endeavors

to

elderly’s social

milestone towards ”ageing begin”. Obviously, like I said

multimodal participation — including with encreasing the

before, this possible milestone is conceptually fragile, being

age

based/

subject to many individual variables; so, a more cautious

proffessional/ coherent programs to support active and

answer to this question could be my former assert, i.e. that it

healthy ageing — is a priority, as already emphasized in my

is difficult (yet) to assume a peremptory input on this

response to your first question) probably the biggest role in

complicated subject matter. 

nondicrimination

of

and

retiremant

enhancement

and

with

of

their

scientifically

EUROMEDS September 2013 } 9

KAROLINA PACIOREK POLAND

problems related to Polypharmacotherapy of Elderly Patients

A

ccording to World Health Organisation (WHO) data, the

effects related to the pharmacological treatment of adult

proportion of the world’s population over 60 years old

patients.

will double from about 11% to 22% over the next 40 years.

The table below lists the top ten conditions known to prevail

This translates to an increase from 605 million to 2 billion

in those 65 years and older.

people- making them the fastest growing age group. Elderly people are encumbered with a higher risk from many health conditions some of which are continuations of preexisting chronic diseases . Most of these conditions however are characteristic of old age and their past medical history. It is therefore becoming one of the biggest challenges of modern medicine to improve the quality of the ageing population.

Due to the need to maintain the health status of the elderly, drug therapy is a crucial need but demands that both pharmacists and doctors be aware of specific risks and side

10 { EUROMEDS September 2013

Heart conditions: vascular disease, congestive heart failure, high blood pressure & coronary artery disease Dementia, including Alzheimer’s disease Depression Incontinence (urine and stool) Arthritis Osteoporosis Diabetes Breathing problems Parkinson’s disease Eye problems (cataracts, glaucoma, Macular Degeneration)

Most of these conditions require poly-pharmacotherapy that

pharmacotherapy that culminates in an inefficient /

involves prescribing several medications. There are two key

suboptimal

terms mandatory to achieve effective pharmacotherapy:

pharmacotherapy failure unfortunately causes a worsening

compliance and adherence. As healthcare professionals, we

of the patient’s condition.

are obliged to achieve both.

Another matter for consideration is that most elderly people

According to Hepler and Strand, there are five main causes

live alone and this poses at least two problems related to

of sub-optimal outcome following the incorrect using of

drug administration. One of such is the challenge posed with

medicine:

inappropriate

the administration of eye drops for example which are

monitoring, patient idiosyncrasy, inappropriate delivery and

frequently prescribed to take care of dry eyes and other eye

inappropriate behaviour of the patient. The last three

diseases. Some patients can also have difficulties with

reasons stated are particularly relevant to elderly patients.

swallowing big or smaller but uncoated tablets. These drugs

Elderly people deserve particular attention in the context of

while uncoated are hard to swallow and coatings affect the

pharmaceutical care for number of reasons.

therapeutic window in the digestive tract.

First and most importantly is the fact that as body ages, it

Another problem associated with administration of drugs is

ceases to function as efficiently as before and physical and

packaging

cognitive disabilities may develop. This influences quality of

Parkinson’s disease who have difficulty opening containers

life as well as the quality of medication in disease

because of trembling powerless hands. These are a few of

management. Many elderly people cannot cope with a

the reasons for non-adherence and non-compliance to

complex medication regime what is imperative for achieving

pharmacotherapy by elderly patients.

optimal outcomes. Reduced visual and cognitive capacity

An additional problem is posed by the use and misuse of

combined with memory loss makes this even more

over-the-counter (OTC)

complicated.

buy over-the-counter medications without any physician

Impairmed vision can be caused by cataracts, glaucoma and

consultation or recommendation. It has been reported that

macular degeneration- common conditions that elderly

about 90% of patients 74.5 years old take 1 OTC drug and

patients suffer from. Patients with blurred vision are unable

almost 50% of them take 2-4 OTC medications.

to properly read labels on drugs or written instructions by

necessary to pay attention to the possibility that a purchased

doctors. This leads to misunderstandings such as omission or

OTC may interact with already prescribed medication.

misuse of medicines.

Unfortunately there is common belief that OTC and herbal

Many older patients suffer from dementia which is

drugs are safe and should not cause any problems. The most

characterised by decline/loss of memory and cognitive

significant drug-drug interactions have been listed in table

functions.

below:

inappropriate

It

can

also

prescription,

lead

to

irregularities

Drug Prescribed

in

medication

which

more

regime.

often

This

affects

resultant

patients

with

drugs. Elderly people sometimes

OTC/Herbal

It is

Effect

Aspirin, Warfarin, Acenocumarole

NSAIDs/ garlic, glycyrrhiza containing medicines,

hyepradditive synergism, increased blood-level of drug, extended time of action, increased risk of bleedings, ulcers & other ADRs

Antihypertensives

NSAIDs

decreased effectiveness

Potassium-saving diuretics (spironolactone)

potassium supplements

Increased potassium level, decreased effectiveness

Drugs metabolized with cytochromeP450 (diazepame, alprazolame, werapamilum, loratadine)

Milk Thistle (Sylibi mariani fructus)

cypP450 inhibition, increased blood-level of drug, extended time of action, increased ADRs

Drugs metabolized with cypP450 (anticoagulants, immunosuppressive drugs)

Hypericum perforatum

cypP450 induction, decreased blood-level of drug, decreased time of action, loss of therapeutic effect

BDZs(Benzodiazepines)

Valerian (Valeriana officinalis)

Additive synergism, intensification of drug’s effect



EUROMEDS September 2013 } 11

Drugs in and by themselves can be causes of adverse drug reactions (ADRs). Incorrect use (including misuse and omissions), combining prescribed drugs with OTC’s and herbal drugs, are still the main reason of adverse drugs effects. It has been reported that ADRs occur in 5% to 35% of patients and account for 12% of hospital admissions of this patient group as well as for increased morbidity and mortality amongst the elderly.

Health care professionals should therefore be more careful and aware of the risks related to polypharmacotherapy of elderly patients, who along with children comprise the most vulnerable groups. 

The Student’s Perspective, I DIKE CHRISTABEL AKPENUCHI UKRAINE Ageing is a natural phenomenon in which the body tissues and organs’ functions start deteriorating. ACTIVE AGEING is a process that allows people to realize their potential for physical, social, and mental well-being throughout the life course and to participate in society, while providing them with adequate protection, security and care when they need. HEALTH according to WHO is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity.

Active and healthy ageing is one of the greatest socio-economic st

challenges of the 21 century. According to statistics, by 2025 more than 25% of Europeans will be 65 or over, with a rapid increase in citizens over the age 80 years old.

Ways to Have People Living Active and Healty While Ageing  AWARENESS: old people in urban and rural areas should be educated on how to stay healthy and active while ageing.

Younger generations also need to be educated right from a youthful age because they have a better understandibg of these issues and will be able to apply them in old age. Families need to be educated too. The family needs to know that the elderly are still important members of society, and should thus be treated with love.  REGULAR EXERCISE AND HEALTY NUTRITION  GOOD SERVICES: When one starts ageing, body tissues and organs gradually start losing their function. The government needs to provide quality and cheap infrastructures (such as the hospital or ageing centre) where the elderly can go and get quality treatments. The ageing ones need regular body examination.  DO THINGS THAT YOU LOVE DOING AND MAKE YOU HAPPY. 

12 { EUROMEDS September 2013

MGBACHI OKWUDILI CELESTINE UKRAINE

active & healthy ageing The Student’s Perspective, II

H

ealth is defined by the World Health Organization

— Adolescence: 13- 18 years. Puberty begins.

(WHO) as ‘a state of complete physical, mental and

— Adulthood: 18- 65 years old.

social well-being’ and not merely the absence of disease or

— Old age: 65 years and above.

infirmity.

Ageing takes place within the social context of friends, work

Human development as a natural process goes through 7

associates, neighbors and family members.

stages, namely:

As defined by WHO, active ageing is the process of

— Prenatal: from birth up to 280 days.

optimizing opportunities for health, participation and

— Infancy: 280 days after birth up till 1year. During this

security in order to enhance the quality of life of ageing

period, it is expected that health is stable and body fat

populations.

becomes a little loose.

Healthy ageing is ‘a long process of optimizing opportunities

— Early childhood: 1-6 years. Marked by the beginning of

of improving and pressuring health and physical, social and

school, control of emotions, development of language with

mental wellness, independence, quality of life and enhancing

an early understanding of this language.

life-course transition’ ( Health Canada 2002).

— Late childhood: Years 6-12, losing of milk teeth and

The overall aim is to extend healthy life expectancy and

development of permanent teeth accompanied by rapid

quality of life for all people as they age while they realize

growth.

their potential for physical, social and mental well-being. 

EUROMEDS September 2013 } 13

RISK FACTORS FOR POOR HEALTH AMONG OLDER PEOPLE

people live in poverty: 4% in Hungary, 5% in Luxembourg,

The major risk factors that predispose to poor health and

% in Estonia.

disease in the older population include: injury, development

— Social Isolation and Exclusion; Mental Disorders.

of non-communicable diseases, poor nutrition, physical

Loneliness, social isolation and its social determinants are

inactivity, tobacco use and harmful alcohol consumption.

risk factors of deteriorating health among old people. In all

These are the major 5 chronic diseases common among

countries, older women have higher risk than their male

elderly people:

counterparts.

— Diabetes

— Maltreatment of the Elderly. This may be physical, sexual

— Cardiovascular diseases

and/or financial abuse/ neglect. An estimated 4 million older

— Cancer

people in the European region experience it every year.

7% in Czech Republic, 51 % in Latvia, 49% in Cyprus and 39

— Chronic respiratory disease

Other predisposing factors are:

WAYS OF IMPROVING ACTIVE AND HEALTHY AGEING:

— Poverty. It increases with old age and it is much higher in

This includes but is not limited to physical activity, healthy

women than in men. European Union prevalence shows that

eating/diet and participation in activities that improve

within the national populations, the following percentage of

mental wellness. 

— Mental disorders.

14 { EUROMEDS September 2013

the cultural contexts of ageing: Preparing Societies for an Ageing Time-bomb FELICITY JONES

Our Changing Global Demographics

UNITED KINGDOM

Ageing in the 21 Century, a landmark report published in

A

st

2012, called the ageing demographic a "megatrend that is cross the globe, our populations are ageing. There is

transforming economies and societies around the world”1.

no doubt that this will dramatically alter the way that

Data from the World Economic Forum suggests that the

societies function and all our social structures – from our

percentage of the global population that is 60 or older has

labour market to our health systems. Whilst all countries

risen from 8% (200 million people) in 1950 to around 11%

have ageing populations, the pace of change, and the stage

(760 million) in 2011, and is projected to reach 22% (2

in the process which countries have reached vary

billion) by 2050 .

significantly. However, it is not just these factors, but also

This ageing population is due to a combination of declining

the social and cultural make-up of the society, and its’

fertility and rising life expectancy, and as such, there are

existing norms and structures, which affect the experience

many reasons to view the change as positive. As Ageing in

of the elderly. Ultimately, these factors have a huge

the 21

influence upon the way in which the country will respond to

humanity’s greatest achievements. People live longer

its changing population structure and are likely to define the

because of improved nutrition, sanitation, medical advances,

extent to which ageing is perceived as a positive or negative

health

process.

Additionally, declining fertility is likely to indicate improved 

2

st

Century states "Increasing longevity is one of

care,

education

and

economic

well-being"1.

1

United Nations Population Fund and HelpAged International (2012) Ageing in the 21st Century: A Celebration and a Challenge, New York.

2

World Economic Forum (2011) Global Population Ageing: Peril or Promise?, Geneva.

global gender equity, as women usually want fewer children

well-being of the elderly and prevent them from

than men. Lastly, a declining fertility rate reduces our

participating in society.

consumption of natural resources, and the damage caused

A paradigm shift could reframe the elderly as an invaluable

to fragile global ecosystems by human activities.

societal source of wisdom and experience, with the potential

However, there is no doubt that if appropriate changes are

to transform younger generations. Additionally, as older

not made, older individuals will pose a significant burden to

individuals form a greater proportion of the population,

countries, through burgeoning pension and care costs.

businesses and politicians might do well to see them as

Therefore, it is critical that governments across the world

holding growing market and political influence.

respond rapidly and effectively to projected demographic change in order to not only mediate against these impacts,

Changing the Social and Cultural Context

but also utilise the skills and experience that many older

Such a paradigm shift in the perception of older persons,

people can offer, for example within the labour force or

and a radical re-writing of social policies to adapt to

voluntary sector.

demographic changes benefits elderly individuals and the whole of society. Both ‘top down’ national policy or societal

A paradigm shift in the perception of older persons, and a radical re-writing of social policies to adapt to demographic changes benefits elderly individuals and the whole of society Importance of the Social and Cultural Context

movements working ‘from the bottom-up’ have the

It is difficult to overstate the importance of social and

potential to lead the change needed to prepare a nation for

cultural factors in determining the experience of a nation to

an ageing time-bomb.

its changing population. National policies and their

China has implemented a number of top-down policies to

implementation in areas such as work, pensions, and health

mediate the change. It is an example of a country that

and social care interact with social norms such as how the

traditionally relied on family-based care for the elderly, a

elderly are regarded and family values, and this combination

filial duty previously taken very seriously. The one-child

has a huge impact upon the wellbeing of the elderly and the

policy introduced in the 1970s accelerated population shifts,

st

society at large – as Ageing in the 21 Century says, “A well 1

and coupled with urban migration of young workers, this has

supported old age is in the interest of all generations” .

led to a break-down in social support for older persons.

Older people should enjoy the same intrinsic rights as

Instead, the elderly have become primary carers for

everyone else, however social age-based discrimination (the

grandchildren- there are 52 million grandchildren looked

use of age as a reason to treat individuals negatively) is

after by their grandparents in rural China . China has

prevalent worldwide. Discrimination experienced by older

introduced a number of national policies to combat these

individuals, particularly elderly women, includes lack of

changes, including pension of £5 a month and a new bill

access to jobs and health care, subjection to abuse, denial of

stating that children must care for their parents’ “spiritual

1

3

the right to own or to inherit property and a lack of minimum income and social security to meet basic needs such as food and shelter. In countries where ageism and age-based discrimination persist, these factors reduce the

16 { EUROMEDS September 2013

3

Spillus, A and Ryall, J (2012) ‘World faces ageing population time bomb says UN’ The Telegraph, 01 October.

needs” as well as their physical needs – which are already 4

protected by law – as they grow older .

In contrast to this approach, a grass-roots approach to supporting the elderly has arisen in Uganda, where 85% of older persons in rural areas live in absolute chronic poverty.

This is due to a combination of factors including poor health, exacerbated by limited geriatric expertise within a weak health system; limited social care, due to loss of children from the HIV pandemic and wars; and a lack of income- as older people have often sold all their assets and are excluded from national development programmes such as the Poverty Eradication Action Plan (PEAP) and the National Agriculture Advisory Development Service (NAADS). Older persons lack a political voice as, unlike other marginalised groups, they are not represented in Parliament, and lack a formally–endorsed

national

policy.

A

national

non-

governmental organisation, The Aged Family Uganda (TAFU) has been established to advocate for the rights of the elderly, and this shows an interesting society-led movement 5

aiming to improve the welfare of older persons .

Conclusion It is impossible to know exactly how the ageing population will affect our societies. However, what is certain is that ignoring these imminent changes will not make them go away, and will not help us to mediate their impacts. Despite the looming time-bomb, many societies remain hindered by government inertia. We all have a duty to ensure our nation prepares, by changing our individual attitudes towards the elderly, changing the social systems within which we work to accommodate the elderly (whether business, health or welfare), and holding our governments to account. With suitable preparation we can minimise the challenges and maximise

the

benefits

arising

from

these

global

demographic changes. 

4

Connon, C (2012) ‘China law forces adult children to visit and care for their elderly parents’, The Independent, 01 July.

5 Nyanzi, F (2008) The Aged Family Uganda, Case Study on the Older Persons of Uganda.

EUROMEDS September 2013 } 17

From Bed-side to Desk-side a confession on how emsa might change your life forever!

NICK SCHNEIDER GERMANY

B

ack in the day, a note on a bulletin board caught my

Thanks to EMSA, the foundation for my career in global and

attention. Anyone interested in founding a local

European health policy was shaped. After graduating, I

chapter of EMSA should come to the cafeteria for a

worked as a researcher and science manager in San

subversive meeting. It was in the late 90s and I had not

Francisco and Heidelberg, on issues I first covered in EMSA:

even finished my first year. The Heidelberg FMO was about

global tobacco control and health advocacy. It took another

to get started. Our first big project was a high-level panel

few fruitful years in US and German academia, to bring me

discussion on the German healthcare system.

back to the core of EU health policy arena. But to be frank, I

Luckily, things did not stop there. After taking over a few

never left it — since I had joined EMSA, back in 1998!

national tasks, Europe called! In total, I probably spent too

It was my Brussels times, which showed me that my future

many years on the EEB, first as Medical Education Director,

would not end behind hospital walls, but behind a desk and

later as President, Liaison Officer to European Medical

in meeting rooms. My patients would not be human, but

Organizations

Permanent

legal. Now, I work for the German Ministry of Health, first as

That position was literally

national focal point for the EU Public Health Programme and

created during a chat at one of the CPME meetings. We were

since late 2012 in the unit for EU coordination. My patients

discussing a solution that should increase the CPME

are now called decisions, regulations and directives, and are

workforce and initiate a permanent student representation

treated jointly with my fellow health (policy) professionals

in Brussels. A win-win situation for everyone involved, but

who are mostly lawyers and health-economists. Caution, if

also a lecture in how things turn out different than expected.

EMSA changes your life, don’t say you were not warned! 

and

mainly

Representative in Brussels.

20 { EUROMEDS September 2013

as

the

first

The Way to Excellence EMSA TNT & TCE DAMLA YAGMUR TURKEY

T

bringing more heat, since we felt as if we were sitting inside a blow dryer. Four faces watched us. Two familiar, two new. I

hose people who wear the dark shirt with a big T on its

knew Fred, I met him during the previous GA, again in

back. You all know them. You have seen them at NCM,

Yeditepe. Orkun has been a friend of mine for two years

at GA, at other events; they even made you take your shoes

now; with Wander and Ana, this would be my first encounter.

off, and sometimes they asked you to build a tower out of

Training New Trainers began. Sleep was out of the picture,

spaghetti – hopefully, uncooked. Yes, I mean the post-it

and challenge became a daily routine. Concepts we were just

enthusiasts, the marker junkies, those who simply cannot

introduced to found no hardship in entering our active

live without their flip charts.

vocabulary. Feedback. Facilitation. Ladder of inference. Flip

I mean the EMSA Training Team, a group of wonderful

chart. Trainee. Ask for help. At the end of the final day,

people who did the nicest of things by accepting me among

“#IloveEMSA” meant “family” for the TNTers. Like sorcerers,

themselves a week ago. So, here go the memories of a fresh

our trainers and fellow trainees took the things we feared

EMSA trainer in her first Training Center of Excellence.

and gave us things we needed instead. I won’t go into detail,

As ten enthusiastic individuals, we entered a classroom on

what happens in TNT, stays in TNT. However, there is this

the second floor of the engineering faculty in Yeditepe

one specific training, a personal experience, that I feel I have

University. The air blowing inside the room must have been

to share with you guys. 

EUROMEDS September 2013 } 21

22 { EUROMEDS September 2013

EUROMEDS September 2013 } 23

And so I was. It was still scary, but now it was also fun. I turned to my other side and looked at Orkun. He looked so peaceful. His arms and legs were floating in the air, as the machine tossed us here and there. Oh, so we weren’t being tossed, we were floating. I let go of my arms and legs as well.

It was the best training ever TNT was over, and the family of fourteen ducks, bursting with excitement and anxiety, started working on their first training deliveries. You could find them discussing, preparing, and dreaming about their sessions in the dormitory, among woods, in the cafeteria, even in the bathroom. Let me tell you, the first thing we learned in TNT got in very handy. “Ask for help.” We asked for it constantly, and we received it. There seemed to be no greater pleasure than helping each other out.

In EMSA-Marmara, our motto is “Bir Elin Nesi Var?” It can be roughly translated to “You can’t clap/make any noise with just one hand.” In other words, making a noise requires at

The fun fair

least two hands. We function better when we work in

I thought I was afraid of heights. In fun fairs, as my cousins

coordination. Certainly, the togetherness adds to the

would run from machine to machine, trying out the fastest,

pleasure of making the noise, too; the TCE reminded me of

the highest, and the craziest of everything, I would always sit

that feeling in a whole new way.

in a corner and watch them be courageous. This time, I was

The process of looking out for each other was not over.

not with my cousins, but I was with my fellow TNTers.

During TCE, all the new trainers, along with Ana, Fred,

Wander was standing in front of a large machine-something

Orkun, Wander, and now Tin, attended each other’s trainings

that turns and throws you around at the same time-and his

and gave each other feedback. Feedback is a gift. Returning

smile was inviting. “Come on,” he was miming, “let’s do this

home after nine long days of TNT and TCE, I put some of the

thing together.”

feedback I received on my wall, so that I can remember the

And so we did. The first few minutes I was screaming like a

potential I have inside of me. Sometimes all one needs is a

teenager in an American b-horror movie. When this thing

pair of friendly eyes to observe and state what is shining in

reached its highest spot, and the “Crown Plaza” inscription

you, and what needs development.

on the nearby hotel turned upside down, my friend Sezgi,

Our trainees, fellow medical students, came in as new faces

who was sitting next to me, said “Damla, calm down. Try and

and new souls to the group. I will never forget those who

enjoy this.” At this moment, when I go back and think about

attended our first training with Goran; asking for help

it, it was not her words that calmed me down. It was the

worked when it came to trainees as well. In our session on

tone of her voice. If she was this calm, I could be this calm as

problem solving, the natural manner in which group work

well.

functioned was mind blowing. In other sessions, as we all spent more time together, the groups started expressing

24 { EUROMEDS September 2013

themselves more and more. This reality was better than my

bring out the best in a person, helping us to see the best in

expectations.

others as well. The Training Center of Excellence is a place

The night before Tin -who was supervising the TCE- returned

where you listen, are listened, make friends, make

home to Zagreb, he explained ’feedback’ to me with these

memories, and the experience does not end when TCE ends.

words, “I try and point out the best in a person, and

It simply keeps on going. 

concentrate on that.” TNT and TCE are experiences that can

EUROMEDS September 2013 } 25

What’s Up, Duck?

ANA GEORGESCU ROMANIA

TCE — Training Centre of Excellence TNT — Training New Trainers

EMSA training events in Istanbul, Turkey

I

f you feel allergic to big old books and studying through the night, then good news is about to come! 2013 is the

third year EMSA opened the door to 10 super-lucky students and provided them with the chance of studying in a nonformal environment.

The event started on the 20th of July, with 4 experienced trainers brought together by the same goal: providing a fun and complex learning experience to EMSAi. The 10 participants arrived eagerly the next day, and so the TNT (within the TCE) started. What if I were to tell you they didn’t study medicine? The main topic of this event is forming trainers, so our awesome medical students learned firstly about themselves (self awareness, attitude, traits, public speaking).

As days past the 10 Duckies (yes, that’s the name of this year’s generation) experienced change in group-dynamics and

interaction,

learned

about

communication

and

interculturality, gained good trainers’ skills and more than anything developed themselves on an emotional and psychological level. The great mix between different backgrounds (medicine, psychology and even technology) was the energy catalyst much needed for a motivating experience.

Not convinced yet? Better try it out yourself next year!! TCE and TNT are awaiting you.  26 { EUROMEDS September 2013

upcoming projects: HIV Unmask-ED Ibukun Adepoju

Upon completing their training, they will carry out regular

EMSA-CSMU & GIZ-UA, UKRAINE

peer sessions with other students within the community, where they can share relevant information on HIV/AIDS that

T

hanks to the huge success of our World Aids Day 2012

is pertinent to the general lifestyle & habits of youth and to

program, our FMO received a call sponsored by GIZ-UA

elicit diverse views on how to combat and prevent HIV.

in January 2013, asking youth to submit innovative ideas

Sessions will include advice on safety and precautionary

specifically targeting the fight against HIV/AIDS.

measures as prophylaxis for contacting HIV and other STI’s,

GIZ-UA is the Ukrainian country office of the German

as well as information on test centres that are available and

organization “Deutsche Gesellschaft für Internationale

open to international students.

Zusammenarbeit” (GIZ) which is involved in numerous

The project also includes a social media component and the

international projects that cut through multiple spheres of

expected results are that this target populations’ risk of HIV

development.

and STI’s is decreased and participants become empowered

Prior to this, GIZ-UA had organised a youth conference in

and more committed to taking care of their health. It is

Kiev tagged ‘Don’t Give AIDS A Chance’ as part of their Fair

equally expected that the stigma shrouding discussions

Play Project which aims at promoting healthy and

about

responsible behaviour among the youth via innovative and

conversations amongst peers, resulting in openness to seek

interesting trainings. As two members of our FMO were

help.

opportune to attend the conference, we had an incredible

Finally, in July (yes, it was a really long, hard wait) we got

chance to experience first-hand the interest and involvement

positive feedback. Proposal accepted - Yay! This is our new

of Ukrainian youth in the fight against AIDS.

journey - one in which we are both optimistic and expecting

Responding to the call for innovative ideas was in the league

the best results. We have recently completed the next phase

of ‘things-we-have-never-done’ as an FMO, but we decided

which involved submitting a more detailed plan of the

to rise to the challenge and therefore assigned a 3-man

project as well as our budget, and we are back to waiting for

working group to brainstorm and put a workable project

instructions and feedback. All being well, we hope the

together on paper. And so it came to be that on the very last

project can kick off fully before the end of this year (2013).

day of February, we sent in our proposal and began the long

Of course, we will remain actively involved in other EMSA

wait with fingers crossed to see if our entry had been

projects and activities, and maybe your own FMO could find

accepted.

a way to re-invent the wheel on this idea to suit your

Our proposed project is entitled “HIV Unmask-ED” with a

environment and the needs of your community.

main objective to bring down the barriers that hinder active

We will keep you posted and let you know how the project is

awareness

developing.

and

discourse

about

HIV/AIDS

in

the

HIV

will

be

broken

and

hence

encourage

international student population in Ukraine, starting off with

And to those FMOs who have a couple of ideas sitting idle on

those within our University.

their things-we-have-never-done list, I would like to say: you

Core tasks include the training of a diverse group of students

will just never know until you try. So, give it a shot as soon

by a facilitator/trainer provided by GIZ-UA and empowering

as the opportunity presents itself and keep all your fingers

these ones to serve as peer educators.

crossed.  EUROMEDS September 2013 } 27

let’s talk about

SEX MATEJ BREZNAR SLOVENIA

We take the awkwardness out of those first steps into adulthood.

among infants. The worldwide incidence of major bacterial and viral STDs is estimated at over 125 million cases per year, while STDs remain hyper endemic in many developing

S

ex is a part of our lives. The fact that we are here today

countries. In the industrialized world diseases caused by

is a testament to this statement. Yet the mere notion

Chlamydia trachomatis, genital herpes viruses, human

that it is a part of our lives does not necessarily mean we are

papillomaviruses and human immunodeficiency virus are

even remotely comfortable talking about it. Why is that? The

nowadays more important than the bacterial ones. Infection

question at hand becomes even more pertinent as we realize

rates are similar among men and women, yet the latter and

that we are surrounded by or better yet immersed into sex.

their respective infants bear the major burden of

Rough, violent, distorted images are constantly pushed onto

complications and serious sequelae. Sexually transmitted

us from different media. Almost every recent major

diseases in pregnant women can result in prematurity,

Hollywood production includes explicit sex scenes. Every

stillbirth and various neonatal infections. In many parts of

other song features overt innuendos and even certain

the world newborns are at risk for gonococcal ophthalmia

respectable newspapers resort to cheap sexual puns in their

neonatorum, a blindness-causing disease, and congenital

titles at times. Thus, we take humanity out of the equation

syphilis for example increases perinatal mortality. Anal and

and substitute it with dim lights, bad script and a whole lot

genital (especially cervical) cancers are associated with viral

of moaning. These wicked illusions are created in order to

STDs (e.g. genital human papillomavirus and herpes virus

help us escape the personal and emotional side of our

infections).

sexuality.

Our project, which we dubbed Let’s talk about Sex, was

The deeper and more obscure themes therefore get even

established to promote safe sex among youth in primary and

less coverage, are swept under the rug or, even worse, are

secondary school and the objectives of our mission are being

rejected by society. Subjects like teenage pregnancy,

realized year after year with noted growth and expansion.

homosexuality and fetishes are met with negative remarks

Medical students visit at least one school per week and

and sometimes even violence. Fear is the main driving force

discuss taboo topics in a relaxed and friendly environment.

behind it as fear dwells in those who are not properly

The project has 20 specially trained instructors with in-depth

educated.

knowledge of the material at hand and an especially keen

Lack of education not only results in abstract ideas of

sense of communication, the right approach and a

fear but also in much more palpable – and often very vivid –

shameless approach. On an annual basis we organize about

sexually transmitted diseases. STDs are now the most

100 lectures and make sure that 2.000 school children get

common group of notifiable infectious diseases in most

adequate answers to their important questions. Teachers are

countries, particularly between the ages 15 and 50 and

enthusiastic about our work because sexual knowledge and

30 { EUROMEDS September 2013

especially questions young people tend to have are far

encourage even the most introverted and shy teenagers to

beyond the scope of the usually rigid curricula. With

open up. Our instructive lecture is concluded with a practical

pleasure they allot two school hours per class to our course,

lesson that includes placing a condom correctly on a banana

which is later usually met with accolades in the form of

until absolutely everyone in class is proficient in this

recommendation letters.

important task.

The core team encourages innovation and spontaneity so no

The project also works at the local level and for the wider

two sessions are the same. We develop and customize

public when we organize awareness campaigns for safe sex

keynote presentations separately for primary and secondary

in shopping centers and at major events, where there is a

schools. In general we work on questions about puberty,

high frequency of our youth demographic. With fun facts at

reproductive anatomy, the menstrual cycle, the first sexual

the stalls we are trying to engage passers-by to test their

On an annual basis we organize about 100 lectures and make sure that 2.000 school children get adequate answers to their important questions. Teachers are enthusiastic about our work because sexual knowledge and especially questions young people tend to have are far beyond the scope of the usually rigid curricula experience, pregnancy, pelvic examination and sexually

knowledge about the fundamental principles of safe sex,

transmitted diseases. Schoolchildren can always ask

awareness of sexually transmitted diseases and knowledge

anything that is on their mind and our answers are

about sexual behavior in general. Activities are extended for

completely honest and as objective as possible. Through

World AIDS Day on December 1st by handing out ribbons,

laughter, funny comparisons and a relaxed approach we

condoms and posters at faculties and at high-traffic locations. Recently we have also organized testing for sexually transmitted diseases. We try to impress upon the public that taking such tests is not a shameful act, but part of a responsible case for one’s own sexual health, and sometimes even more importantly – for the health of others we may care deeply about.

Limited funds have not stopped us from planning future activities. Our top priority at the moment is the development of a mobile application, intended for both iOS and Android. It will be designed as an interactive game, directed toward younger generations, which will subtly teach and explain the importance of safe sex, empower them to talk about it and offer information about growing up. Players will also be able to post questions and search for relevant answers from within the app itself and get answers back from our instructors, each tailored for the individual. The vast ď ˝

EUROMEDS September 2013 } 31

Our unique and relaxed approach gives us the edge we need in bringing teenagers closer to a healthier sex life. That does not limit our discourse only to safe sex but to better understanding and embracing our sexuality as a whole.

Do you think we are doing the right thing? Start a Let’s talk

about Sex branch in your FMO and spread the word, not the disease.  adoption of smartphones in the key demographic helped us estimate that the application may have a much greater and lasting impact, due to engagement, than giving lectures in class alone. Not to overlook the fact that this will be an interesting and unprecedented public health experiment with new technologies.

Other project goals include launching our independent website, increasing the frequency of accessible HIV testing, testing for other sexually transmitted diseases, teaching safe sex to the elderly in retirement homes, and of course connecting with sister projects in other countries.

Let’s talk about Sex may still be a relatively young project but we are determined, motivated and passionate enough to succeed in delivering our message.

32 { EUROMEDS September 2013

my.medicinec.si/talk-sex loveandsex@medicinec.si

The United School of Neuroscience GINTAR ZUKAUSKAITE, DZIUGAS MESKELEVICIUS KAUNAS, LITHUANIA With clear fundamental understanding, proficiency comes as you walk.

T

he purpose of the School of Neurosciences is to help

Usually, the three day program comprises of 10-12 lectures,

the future doctors in neuroscience-related fields, such

each lasting two academic hours, totalling an average of 7

as psychiatry, neurology and neurosurgery, embrace more

academic hours of lectures per day. Thus, the school is

knowledge about the human brain, than is usually provided

rather intense; however each evening is left entirely for

in the curriculum. This is the mission of the school, to help

leisure with bath, pools, table tennis and billiard as well as

every medical student form a mental bridge in the gap

table games and dances.

between pure neurosciences and applied medicine.

Here is a detailed description of events that took place in

The school takes place once a year, starting on Friday to end

years 2012 and 2013.

on Sunday. The event was held in a homestead adapted to

The United School of Neuroscience was first organised in

conferences

contrasting

2012, between the 4th and 6th of May, by members of the

environment provides a unique experience as the audience

Lithuanian University of Health Sciences - Students Medical

is disconnected from the hours of hard academic work and

Association members (by the chairmen of the clusters of

lectures during a few short breaks. This contrast serves the

neuroscience, neurosurgery and psychiatry). The United

students well; due to the fact that the lectures are ended

School of Neuroscience took place in Kazlu Ruda, homestead

with a short summary, we make sure the key points are well

“Retro”, Lithuania.

and

official

events.

This

remembered and although the breaks between the lectures are short, the students come back to the following lecture well-rested.

The scientific fields that were covered in the school during the last two years are the following: — Neuroanatomy; — Neurophysiology;

The mission of the school is to help every medical student form a mental bridge in the gap between pure neurosciences and applied medicine

— Molecular biology and biochemistry; — Neurology;

The School was attended by 30 participants from Lithuania,

— Psychiatry;

the majority being medical students from Lithuanian

— Neurosurgery;

university of health sciences (LUHS) and one being a

— Developmental neuroanatomy and embryology;

psychology student from Vilnius University, all of them

— Neuroinformatics.

interested in neurology, psychiatry and neurosurgery. They 



EUROMEDS September 2013 } 33

clinical cases (participants were supposed to ascertain the diagnosis).

Day one included 3 plenary lectures on the basics of neuroscience: neuroevolution, neuroanatomy and the mesolimbic system. The neuroanatomy lecture concentrated on the structure of the telencephalon, cerebral cortex and basal ganglia. The lecture of mesolymbic system was given by a student. The lecture of neuroevolution allowed students to compare the nervous system of people and the one of some mammals.

Day two included 5 lectures and one practical session: the acetylcholinergic system of the brain, neuroembriology, radiology

of

the

brain,

practical

training

of

electroencephalography, common psychopathology and the examination of a neurological patient.

During the practical training of electroencephalography participants were taught to analyse electroencephalograms.

After this lecture students were divided into groups, where they had to apply the acquired knowledge and analyse other EEGs. Day three: Brodmann’s area and their violations. Before the lecture all the participants got a piece of paper with the depiction of an uncoloured brain. The presenter devised a system which could help people remember the positions of Brodmann’s Areas and which was showed to the students.

The participants drew them on the uncoloured brains. Also participants were taught about violations of areas and their outcomes.

Another lecture: reticular formation and reticular activating system (RAS). This was also presented by students, with noteworthy and engaging participants in discussion, too.

A practical session followed - a game of clinical cases called “When I grow up, I ll be Forman”. A few students presented clinical cases and the participants had to ascertain the were

taught

by

LUHS

lecturers

and

doctors,

but

diagnosis.

presentations were also given by students and residents.

After the scientific days full of lectures, participants had a

During 3 days there were presented 10 lectures. After each

great opportunity to recreate and unbend their minds. There

lecture participants had a great opportunity to ask questions

was a bathhouse, a swimming pool, table games and so on.

and they had really great and significant discussions. Also

Also in the first evening the organizers had a surprise for the

there were organized two practical sessions where

participants: they arranged a

participants were taught to analyze EEG and presentations of

ending of a day!

34 { EUROMEDS September 2013

brain fight . It was a great

One year later, The United School of Neuroscience was

A professor of psychiatry represented a lecture of the

organized for the second time. We could say that it has

interesting cases in psychiatry. Firstly,

lecturer taught

become a nice tradition. In 2013, topics of the lectures

academic

the

focused on particular branches of neuroscience such as

syndrome. Secondly,

neuroinformatics, neurosurgical treatment of Parkinson s

practice. After this lecture there was a huge discussion. The

disease, pediatric anorexia nervosa, cellular mechanisms of

participants were astonished and the discussion continued

memory, stem cells, interesting cases in psychiatry and the

much longer than it was expected.

neurophysiology of vision.

In the Lithuanian University of Health Sciences there are

The lecture about neuroinformatics was absolutely new for

lecturers who have been working in the area of

the students, but unfortunately it is not included in the

Neurophysiology of vision for many years. In the united

educational material for medical students. They received a

school of neuroscience the initiator of this branch presented

lot of new and interesting information which astonished

the history in full details and photos of how this science has

them.

been developed in Lithuania. Of course the main point of the

The neurosurgical treatment of Parkinson s disease was

Lecture was the theory of neurophysiology of vision. Medical

presented by a first year neurosurgery resident. The lecture

students have had a similar lecture about this science in the

was comprised of two parts. The speaker discussed the

third year of studies. But in the united school of

changes in the brains of patients affected with Parkinson s

neuroscience the lecture was much longer and obviously

disease and presented them by using real photos in his

more understandable. The history of how the professors

presentation; he also showed students every step of the

developed this science in Lithuania, colored the lecture in

operation that is available for these patients. And after the

bright colors and inspired the students to reach their

lecture, the speaker showed videos in which participants

purposes.

could see the patients before and after the surgery.

After the lectures, students had many opportunities to relax

The lecture regarding cellular mechanisms of memory was

and recreate. The united school of neuroscience had a great

given by a lecturer of physiology. Medical students have a

success and the organizers promised to continue this nice

similar lecture in their third year in medical school. But the

and educational tradition next year! ďƒŞ

material,

concentrating

on

Klerambo

he gave many examples from his

lecture, which was presented in the united school, was really clear and very interesting. Students had a great opportunity to remember and repeat this material and to deepen their knowledge in this range. It was followed by a thorough discussion with many questions.

Stem cell technology and its possible applications in medicine - this lecture was given by the deputy director for science of the Institute of Biochemistry of Vilnius University.

Students were introduced to or reminded of the concept of cell differentiation, dedifferentiation and stem cell, its possible uses in applied medicine, and also current issues with this application, both technical and ethical. In the end of this lecture a lively discussion between the students and lecturers was ignited, where new questions were both raised and answered simultaneously.

EUROMEDS September 2013 } 35

Attending an International HIV Conference: opportunities for med students SOFIA RIBEIRO

WHO new consolidated guidelines on HIV that were launched

EMSA VICE-PRESIDENT FOR EXTERNAL AFFAIRS, PORTUGAL

during the conference at www.who-int/hiv/en/ along with

I

other important resources featured on the website. I was

n June 2013 I had the amazing opportunity to attend one

surprised about the travel restrictions that still exist in

of the biggest conferences on HIV organized by the

several countries and that highly stigmatize HIV patients. If

International AIDS Society (IAS), held in Malaysia. Delegates

you are interested in this topic, you can find more

came from all over the world to attend a conference where

information on The Global Database on HIV specific travel

HIV was the main topic, but where everyone were welcome,

and residence restrictions at www.hivrestrictions.org. There

from basic to clinical science, including epidemiology and

was also a study visit and I was pleased to see closely what

advocacy. I was surprised to see such an inclusive

PT Foundation was doing locally to provide HIV-testing and

conference — every participant could find something

support for newly diagnosed HIV-positive patients in

interesting for him or herself: researchers, medical doctors,

Malaysia. Soft skills were not forgotten and I attended an

community leaders and advocacy groups, just to name a few.

excellent workshop on getting our scientific articles published: “Publish or Perish”. Fortunately, the handouts were made publicly available at www.bit.ly/hivhandout and I

I was surprised about the travel restrictions that still exist in several countries, that highly stigmatize HIV patients

strongly recommend them, should you be interested in publishing a scientific article soon, HIV-related or not.

I came back home full of practical knowledge that I will apply in my daily practice as a Medical Resident in Public Health, and ideas for research projects on HIV that I could carry out within my community. Although I was attending the conference on a personal basis, the spirit of an EMSA board

The conference lasted a total of four days, during which I

member is always there, and I took this opportunity for

mainly attended sessions focusing on HIV prevention. If you

networking with several organizations, with both European

are a medical student or junior doctor, have a look at the

and Global outreach. I am proud to say that all these efforts

36 { EUROMEDS September 2013

materialized into something we will offer EMSAi during the

Once again, I would like to thank IAS for the scholarship that

General Assembly in Lisbon, Portugal. We will have two

allowed me to attend such an interesting conference and

international speaker guests: Ms Tamara Torroni (IAS), who

acquire considerable knowledge on the field of HIV, not to

will present all the different opportunities IAS has to offer

mention the opportunity of gathering all these amazing

medical students and young doctors, and Dr. Stephan

contributions for our upcoming General Assembly. I am

Dressler (European AIDS Treatment Group, EATG), who will

strongly confident that more medical students across Europe

deliver a presentation on the opportunities EATG has to offer

will be active on HIV topic from now on! ďƒŞ

medical students and a workshop on how to communicate with HIV patients and avoid discrimination. For those really interested in the topic or just curious about it, please join us!

If you will not be at the General Assembly, we will do our best to gather information and produce comprehensive handouts.

EUROMEDS September 2013 } 37

Healthcare Professionals play a leading role in diabetes & and prevention

W

ith this piece, we wish to say hello to all EMSA

the only pan-European audit on the evolution of the diabetes

members and EMSA magazine readers. This

epidemic and national policies and practices existing across

article is a short introduction to IDF Europe

the

Europe will be seeing its 4th edition being published in

Diabetes

November 2014. In addition, IDF Europe is currently working

Federation, who we are as an organisation and what we

on a Survey on Access to Quality Medicines and Medical

do. We look forward to building a dialogue with young

Devices for Diabetes Care in Europe. This publication is the

health care professionals through EMSA with the aim of

first survey of its kind in the field of diabetes and will be

improving the lives of people with diabetes and those at

launched on World Diabetes day in November this year.

risk.

In addition, IDF Europe is instrumental in advocating for the

European

branch

of

the

International

rights and voicing the needs of people living with diabetes

Who is IDF Europe?

and those at risk.

IDF Europe is an umbrella organisation representing 66

IDF Europe has also a key role to play in raising awareness

diabetes organisations in 47 countries across Europe. We are

through campaigning on World Diabetes Day, promoting

a diverse and inclusive multicultural network of national

healthy and active lifestyles and supporting research

diabetes associations representing people with diabetes and

projects.

health care professionals.

We also take great responsibilty in engaging with our

Together, we work to influence policy, increase public

members – national diabetes associations through sharing

awareness and promote the exchange of best practice to

expertise, knowledge and resources, nurturing a new

prevent diabetes and improve the lives of people with

generation of youth advocates and collaborating on

diabetes in Europe.

regional, national and local initiatives.

IDF Europe is the leading voice for the growing number of people living with

IDF Europe’s Youth Movement

diabetes and those at risk.

IDF Europe values the essential role youth plays in raising awareness on diabetes and shaping today the policies that

What does IDF Europe do?

will affect the future. To strengthen its relationship with

IDF

young people with diabetes, IDF Europe organises a yearly

Europe

provides

up-to-date

evidence. The Diabetes Policy Puzzle;

40 { EUROMEDS September 2013

Youth Leadership Camp.

As more and more children and young people live with

— Europe is home to the highest number of children with type 1 diabetes in the world

diabetes, it is not only vital

— One in ten deaths in Europe can be attributed to diabetes

that the voice of youth be

— At least 88.8 billion EUR are spent each year to treat

heard, but also that they play

diabetes in Europe

an active role in IDF Europe’s

If we do not implement the measures necessary to reverse

mission to promote diabetes

the diabetes epidemic, health care systems will soon no

care, prevention and a cure

longer be able to care for people with diabetes. Cost-

worldwide.

effective strategies that focus on multi-disciplinary care,

Their first-hand experience of

health promotion and diabetes prevention are key in

diabetes makes young people

improving the lives of people living with diabetes and

with

powerful

helping those at risk of developing this chronic condition.

urge

These strategies do exist, and the sustainability of health

diabetes

advocates

to

stakeholders and the general public to take action on

care systems across Europe depends on them.

diabetes. In addition, their broad network built through

The time to act is now, both in tackling this growing

social media is beneficial to IDF Europe’s outreach.

epidemic and in improving the lives of those living with

The first IDF Europe Youth Leadership Camp was held in July

diabetes. Realising the importance of developing good

2011, and has been held every year since. Now in its third

communication skills and relations with patients at this early

year, the IDF Europe Youth Camp is a real success. During

stage of your career is key to successful doctor-patient

the camp, youth advocates from all over Europe learn about

interaction and collaboration, mutual respect and trust,

different types of advocacy, campaigning activities and

patient empowerment and treatment compliance. We call on

strategic planning methods, and are also introduced to the

you, future health care professionals of Europe and the

work of IDF Europe. Combining sports activities and

world to be sensitive to the growing burden of diabetes and

interactive workshops, the camp is also an opportunity for

non-communicable diseases. The skills and knowledge you

the youth advocates to find out about the differences in

are developing are instrumental not only in providing care

diabetes care and daily-life realities across Europe, share

and treating but also in preventing diabetes. 

their strategies on how to cope with diabetes and learn from their day-to-day triumphs and challenges.

An inevitable result of the camp is peer-to-peer learning.

Back in their countries, the young leaders are inspired and eager to get more involved in raising awareness on diabetes

IDF EUROPE Chaussee de La Hulpe 166, BE-1170 Brussels, Belgium T +3225371889, F +3225371981 idfeurope@idf-europe.org www.idf-europe.org

at national level.

Diabetes in Europe: the facts A quick reminder on the growing epidemic and burden of diabetes: — 55 million people live with diabetes in Europe. That is 8.5% of the population — At least 21.2 million people are yet to be diagnosed

EUROMEDS September 2013 } 41

O Fortuna...

POLONA SAVIC EMSOC

I

t was summer again and I found myself standing on the

dinner evening, where the participants prepare their

train station, suitcase packed and a smile on my face,

national food. With all this going on, we still managed to do

waiting for the train to take me away.

It was starting

a flash mob of Orffs O Fortuna in a local shopping center to

again…

promote our concerts.

EMSOC was founded in 2009 in Ljubljana, when European

The week ended with two concerts, where we performed

medical students’ orchestra (EMSO) and European medical

Carl Orff’s Carmina Burana and ZoltÆn KodÆly’s Dances of

students’ choir (EMSC) were joined. EMSO was founded in

GalÆnta and Esti dal. The first concert was at the Open-Air

Würzburg in 1993 and EMSC in London in 1996. The goal of

Festival in Szeged with approx. 750 listeners. The profit from

both projects was the same: to give the medical students

the concert was donated to the University of Szeged, the

from all over Europe the opportunity to meet new people,

Department of Anesthesiology and Intensive Care Unit. The

visit new places and to make music. They have performed

second concert was enjoyed by approx. 250 listeners at the

world’s greatest music pieces all over Europe, changing the

Italian Institute of Culture in Budapest, while the profits went

venue every time from Berlin, London, Oslo, Stockholm to

to Semmelweis University, Budapest – the 1st Department of

Rome, Porto, Barcelona, Ljubljana, Budapest and many

the Pediatric Clinic.

more. In 2009 the union proved to be so successful that they

After the official part was over, some of us just couldn’t go

have been performing together ever since.

home yet, so we enjoyed a few more days discovering

This year we enjoyed ourselves in the beautiful Szeged

Budapest and relaxing on the shores of the Balaton Lake.

under the hot Hungarian sky. The event was organized by

and Semmelweis University of Budapest from 18th of July till

What about next year?

Bilbao, Spain. We hope to see you there!

29th of July 2013. During the week we had musical

For more information on future EMSOC events and for a

rehearsals, explored Szeged and a bit of Budapest and

glimpse of the memories from previous events, visit our

visited Biczó CsÆrda village on our day trip. Of course,

website at www.emsocinfo.org 

the former and present students of the University of Szeged

EMSOC is not complete without the traditional International

42 { EUROMEDS September 2013

Future of AMSA-EMSA JIAWEI LI AMSA LIAISON OFFICER

A

sian Medical Student Association (AMSA) is the largest

Chapters expressed their enthusiasm to be involved in this

organisation of medical students in the Asia-Pacific

historic event.

region, formally founded in Manila, Phillippines at the 6th

The twinning project will provide many benefits to both

Asian

Our

EMSA and AMSA members. This provides the opportunities

membership includes 23 full and observer chapters across

for EMSA members to observe more closely health and

the region which include: Australia, Bangladesh, Cambodia,

social problems experienced in Asia. EMSA members can

China, Egypt, Hong Kong, Indonesia, India, Japan,

also notice the difference in the medical education in Asian

Malaysia, Mongolia, Myanmar, Nepal, New Zealand, Pakistan,

countries.

Palestine, the Philippines, Singapore, South Korea , Taiwan,

understand the health care systems in our counterpart. In

Thailand. AMSA organises annual scientific conferences and

addition, this would allow students to travel to a completely

theme-based activities, including academic paper reviews,

different country, experiencing the culture, education and

public health and humanitarian projects and student

social activities. It would prove to be a valuable experience

exchange programme

to broaden our horizon as medical students.

EMSA and AMSA, the two medical student organisations, are

This year is going to be a special year for both AMSA and

currently in the preparation of a Memorandum of

EMSA. An exchange programme between Asian Medical

Understanding. This would serve as an agreement to further

Student

strengthen the bonds among medical students across the

Association has long been anticipated by the both parties.

globe. The committee members have been working hard,

This year, we are going to make it into a reality. Hopefully,

planning the first exchange programme between AMSA and

the result of this program can serve to as a pioneer for

EMSA. During the first meeting of Asian Medical Students’

further

Exchange Programme (AMSEP), all participating Asian

organizations. 

Medical

Student s

Conference

(AMSC).

Conversely, AMSA members can learn and

Association

exchange

and

European

programmes

Medical

between

Student

the

two

EUROMEDS September 2013 } 43

European Medical Students’ Association c/o CPME, Rue Guinard 15, 1040 Brussels, Belgium www.emsa-europe.eu emsa-eb@googlegroups.com