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1.
A cross-sectional study combined anthropologic (ethnographic) techniques to obtain qualitative information from decision makers and a questionnaire designed to investigate the population that used health services provided by the medical centers in Mexico. The results demonstrate that non-biomedical therapists fell into three main groups: (1) practitioners of traditional medicine; (2) practitioners of alternative medicine; and (3) faith healers. The cultural affiliations, academic backgrounds, training, and preparation of these practitioners differed markedly. They employed many strategies to finance their services, create and utilize therapist networks, and provide care to different segments of the population. The authors recommend further research on non-biomedical health care models, which are becoming more important with expanding globalization.  相似文献   

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《Global public health》2013,8(6):626-638
Abstract

Lay health care workers (promotores) interviewed 313 female members of remote Indian groups in northern Baja California, Mexico regarding: (1) common childhood and adult illnesses and endorsement of ‘traditional’ and modern therapies; (2) illness causation beliefs and knowledge of biomedical principles; and (3) the relation of ethnic identity with concepts of effective biomedical and non-biomedical therapy. The most common illnesses/symptoms reported in adults were diabetes, hypertension, high cholesterol, cold/flu, diarrhoea, low/variable blood pressure and arthritis; and in children, cold/flu, diarrhoea, bronchitis, cough, fever, empacho and dehydration. Of 285 informants, more reported at least one childhood disorder than who reported at least one adult disorder was most helped by traditional therapy [83 (29.1%) versus 44 (15.4%); P<0.0001] and both therapies [81 (28.4%) versus 42 (14.7%); P<0.001]. They reported eight naturalistic and two personalistic illness causes and manifested variable biomedical knowledge. Indian or mixed Indian/Mexican ethnic self-identity predominated, and Indian identity was unrelated to endorsement of traditional therapy. The ‘biocultural synthesis’ is a useful theoretical framework for viewing the findings. The Indians' pluralistic concepts have important implications for public health care workers and biomedical practitioners.  相似文献   

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精准医学是一种将个体基因、环境与生活习惯差异考虑在内的疾病预防与治疗的新策略,旨在对疾病进行精确分类及诊断,为患者提供个性化、更具针对性的预防和治疗措施。大规模人群队列研究是精准医学研究的重要基础,能够为精准医学实践提供循证医学的最佳证据。对精准医学的批评与质疑主要集中在受益人群少、对健康社会决定因素的忽视以及可能导致有限医疗资源的浪费。尽管这样,精准医学仍然是一个“希望无限的领域”,并有望成为未来医疗保健的实践模式。  相似文献   

5.
India has a plurality of health care systems as well as different systems of medicine. The government and local administrations provide public health care in hospitals and clinics. Public health care in rural areas is concentrated on prevention and promotion services to the detriment of curative services. The rural primary health centers are woefully underutilized because they fail to provide their clients with the desired amount of attention and medication and because they have inconvenient locations and long waiting times. Public hospitals provide 60% of all hospitalizations, while the private sector provides 75% of all routine care. The private sector is composed of an equal number of qualified doctors and unqualified practitioners, with a greater ratio of unqualified to qualified existing in less developed states. In rural areas, qualified doctors are clustered in areas where government services are available. With a population barely able to meet its nutritional needs, India needs universalization of health care provision to assure equity in health care access and availability instead of a large number of doctors who are profiting from the sicknesses of the poor.  相似文献   

6.
Allopathic practitioners in India are outnumbered by practitioners of traditional Indian medicine, such as Ayurveda and Siddha. These forms of traditional medicine are currently used by up to two‐thirds of its population to help meet primary healthcare needs, particularly in rural areas. Gandeepam is one of the pioneering Siddha clinics in rural Tamil Nadu that is specialized in providing palliative care to HIV/AIDS patients with effective treatment. This article examines and critically discusses the perceptions of patients regarding the efficacy of Siddha treatment and their motivation in using this form of treatment. The issues of gender equality in the access of HIV/AIDS treatment as well as the possible challenges in complementing allopathic and traditional/complementary health sectors in research and policy are also discussed. The article concludes by emphasizing the importance of complementing allopathic treatment with traditional medicine for short‐term symptoms and some opportunistic diseases present among HIV/AIDS patients. Copyright © 2012 John Wiley & Sons, Ltd.  相似文献   

7.
The purpose of this cross-cultural study was to evaluate patient perspectives on complementary and alternative medicine (CAM) integration within primary care clinics. It is one of the first multiethnic studies to explore patients' perspectives on the best model for integrating CAM into the conventional care setting. We developed a 13-item questionnaire that addresses issues of CAM use, expectations from the primary care physicians concerning CAM, and attitudes toward CAM integration within a patient's primary care clinic. We constructed the questionnaire with cross-cultural sensitivity concerning the core concepts of CAM and traditional medicine in both the Arab and Jewish communities in northern Israel. Data for statistical analysis were obtained from 3840 patients attending seven primary care clinics. Of the 3713 respondents who were willing to identify their religion, 2184 defined themselves as Muslims, Christians, or Druze and 1529 as Jews. Respondents in the two groups were equally distributed by sex but differed significantly by age, education, self-rated religiosity, and self-reported chronic diseases in their medical background. Respondents in the two groups reported comparable overall CAM use during the previous year, but the Arab respondents reported more use of herbs and traditional medicine. Respondents in both groups stated that their primary expectation from a family physician concerning CAM was to refer them appropriately and safely to a CAM practitioner. Respondents in both groups greatly supported a theoretical scenario of CAM integration into primary medical care. However, Arab respondents were more supportive of the option that non-physician CAM practitioners would provide CAM rather than physicians.  相似文献   

8.
This paper argues that because Ayurveda is commonly approached as a single coherent tradition of medicine characterized predominately by the doctrines, clinical practitioners, and medical infrastructure that supports it, the rich diversity of empirical indigenous medicine available in the daily lives of the Sinhalese is often obscured. Thus the numbers of IMPs, the wide range of services they provide, and the importance of Ayurveda and Sinhala medicine as basic explanatory models of health and illness within the general population may be significantly under-estimated in analyses of Sri Lanka's medical system. In practice, Ayurveda is a dynamic phenomenon that offers multifaceted approaches to healing. These diverse healing formats develop to meet the constantly changing needs of the society and of illness patterns. This analysis views illness and health care in terms of the multiple systems of knowledge and action, phenomena and interaction, that characterize them as well as in terms of the medical treatises and institutions that formalize them. In this light, Ayurveda emerges as a plural medical system in itself. As such, it remains a fundamental means of defining and treating illness in Sri Lanka.  相似文献   

9.
Recent research has revealed that the health care of India's rural population is being provided by private practitioners. With as many as 1,250,000 private practitioners providing health services to at least half of India's population, three studies were conducted to shed light on the profile and practice of the private practitioners. It was found that the private practitioners are almost always male, practice in or close to their birthplace, and have attended school. Only 25% are graduates, however, and almost 50% have no formal training. Regardless of training, nearly 90% practice allopathy. In a study of 542 patients, no physical examinations were conducted in 47% of the cases, but the patients were satisfied with the care they received because the private practitioners paid more attention to them than they were accustomed to receive from primary health care doctors. The private practitioners are compensated by adding a surcharge to the fee for medicines. The patients believe that they are simply purchasing medications. This system requires the practitioners to dispense medications, injections, or both to receive compensation. Medications, including antibiotics, are given in small doses (a practice which is certainly harmful). The practitioners refer difficult cases to the government centers. Most of the practitioner, however, practice alone, with their only professional contact being the town chemist. Almost all of these practitioners expressed interest in joining an association. Analysis of the cost of this health care shows that it accounts for a substantial portion of rural expenditure and constitutes a sizeable hidden "industry." In order to respond to this situation, the government must either ban the untrained rural private practitioner, promote the quality of care provided by the government network, or acknowledge the existence of the private practitioners and provide them with support and training.  相似文献   

10.
BACKGROUND: Despite family practitioners frequently being requested to assist their patients with advice on or referrals to complementary-alternative medicine (CAM), there is an absence both of evidence about the efficacy of nearly all specific treatments or modalities and of guidelines to assist with the integration of conventional and CAM therapies. OBJECTIVE: The aim of this article is to suggest a comprehensive and rational, best-evidence strategy for integrating CAM by primary care practitioners into primary care, within the context of the limitations of the current knowledge base and the local milieu. METHODS: The suggested approach was developed by a combination of literature review, key informant interviews, focus groups, educational presentations for family practice residents and practitioners, and field testing. An iterative model was utilized whereby more refined drafts of the suggested approach were subjected to later discussants and groups, as well as further field testing. Drafts of the strategy were utilized in consultations of patients requesting advice on alternative medicine in a primary care setting and in a CAM clinic. RESULTS: Both family physicians and CAM practitioners provided useful comments and recommendations throughout the process. These can be categorized in terms of knowledge, attitudes and skills. Our strategy suggests that patients requesting advice on the use and integration of CAM modalities as part of their health care should be evaluated initially by their primary care physician. The physician's responsibilities are to evaluate the appropriateness of that use, and to maintain contact, monitoring outcomes. Advice on referrals should be based on the safety of the method in question, current knowledge on indications and contraindications of that modality, and familiarity and an open dialogue with the specific therapist. CONCLUSIONS: Given patients' demands and utilization of CAM therapies, despite the lack of evidence, there is an increasing need to address how CAM therapies can be integrated into conventional medical systems. These suggestions should respond to patient's expectations and needs, but at the same time maintain accepted standards of medical and scientific principles of practice.  相似文献   

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