Referral to and attitude towards traditional Chinese medicine amongst western medical doctors in postcolonial Hong Kong

Recognizing the international trend for patients to choose both allopathic western medicine (WM) and traditional, complementary and alternative medicine (TCAM), the World Health Organization has called for stronger collaboration between WM doctors (WMD) and TCAM practitioners. This resonates with the situation in Hong Kong where the dominant modality of patient care is primarily based on WM practice while traditional Chinese medicine (TCM) is often used as a complement. The roots of this utilization pattern lie in colonial history when TCM was marginalised during the British administration. However since 1997 when China regained sovereignty, policies to regulate and professionalize TCM practices have been formally introduced. Despite both its popularity and this policy shift, progress on implementing collaboration between WM and TCM clinicians has been slow. This study, the first since 1997, explores current attitudes and referral behaviours of WMD towards use of TCM. We hypothesised that WMD would have positive attitudes towards TCM, due to regulation and cultural affinity, but that few actual TCM referrals would be made given the lack of a formal collaboration policy between elements within the healthcare system. Our results support these hypotheses, and this pattern possibly rooted from structural inhibitions originating from the historical dominance of WM and failure of services to respond to espoused policy. These have shaped Hong Kong's TCAM policy process to be closer with situations in the West, and have clearly differentiated it from integration experiences in other East Asian health systems where recent colonial history is absent. In addition, our results revealed that self use and formal education of TCM, rather than use of evidence in decision making, played a stronger role in determining referral. This implies that effective TCAM policies within WM dominated health systems like Hong Kong would require structural and educational solutions that foster both increased understanding and safe referrals.     

Medical pluralism and medical marginality: bone doctors and the selective legitimation of therapeutic expertise in India

Current health policy initiatives in India advocate medical pluralism and seek to address a lack of skilled human resources for health care provision. This qualitative study investigated a form of indigenous therapy that does not fit into officially recognised categories of 'Indian medicine' but is a popular source of informal medical care. Semi-structured interviews and ethnographic observations of 30 'bone doctor' (haad vaidya) practices were conducted in the capital city of Rajasthan, north India in 2009-2010 together with historical analysis of changes in state policies for the registration of Indian medicine practitioners. Contestations over legitimacy among individual practitioners and hierarchies of authority between different medical traditions are shown to rest on conceptions of what constitutes authentic 'expertise'. The findings demonstrate a progressive restriction over time in official definitions of medical expertise, towards a reliance exclusively on formal qualifications rather than experientially acquired and inherited skills to demarcate legitimate therapeutic knowledge. This case study contributes to our understanding of the nature of non-professional expertise and its implications for pluralistic health care policy and the human resourcing of Indian health systems.     

Immigrants and equitable health-care delivery in rural areas

ABSTRACT: In response to settlement patterns in Australia, most immigrant specialist services and programs have been developed in metropolitan locations and large provincial cities. However, immigrants have also settled in smaller numbers in country locations. It is of concern, therefore, to consider how responsive and equitable health-care services can be delivered in country regions when immigrants do not reach the critical mass that would warrant the development of specialist services. This paper draws on a consultation conducted in South Australia to propose a way forward in linking country health services with local immigrant communities and immigrant specialist services in cities.     

Attitudes towards community medicine: a comparison of students from traditional and community-oriented medical schools

OBJECTIVE: To compare the attitudes towards community medicine of first and final year students from two Australian medical schools. METHOD: In 1995, medical students from Newcastle University (a problem-based, community-oriented curriculum) and Adelaide University (a more traditional lecture-based curriculum) were asked to complete the Attitudes to Community Medicine questionnaire. This is a valid and reliable 35 item survey assessing six key domains of community medicine. The two medical schools differ in their methods of selection and curriculum delivery, and also in curriculum content. RESULTS: Response rates averaged 95% for first year and 81% for final year students. Students selected into both medical schools were found to have positive attitudes with respect to most aspects of community medicine. However, those entering Newcastle had more positive attitudes toward community medicine overall than their Adelaide counterparts. They also scored more positively on subscales relating to holistic care and evaluation of health care interventions. Students who were older and female scored more positively on some subscales, but correction for age and gender did not change the conclusions about medical school differences. CONCLUSION: This study suggests that selection criteria, and probably curriculum style and emphasis, have an influence on the attitudes that medical students possess and later develop toward community medicine.     

Maternal and neonatal service delivery by traditional birth attendants in rural Benin: A case for integration?

ABSTRACT

The Republic of Benin faces high maternal, newborn and child (MNCH) morbidity and mortality. Traditional birth attendants (TBAs) continue to operate on the margins of the health system yet provide critical services to women and children. This study aims to further the understanding of TBA’s scope of practice for developing appropriate strategies to strengthen MNCH services at the community-level. TBAs were identified and surveyed on education, training, system support and scope of practice including management of obstetric and newborn emergencies. TBAs were found to perform diverse preventive and health promotion activities, including antenatal and newborn care counselling, promotion of family planning and immunizations. Among 109 TBAs, 11,102 births were documented in the prior year with a maternal mortality ratio (MMR) of 790/100,000 and neonatal mortality rate (NMR) 12.2/1000. The scope of TBA practices is broad and rural communities rely on this cadre for services. However, TBAs report higher rates of adverse maternal events compared to national statistics. Better understanding is needed on community preferences, training and methods of participation of TBAs within the health system. This could improve identification and referral for emergencies, reinforce safer practices and increase preventive and promotive health activities at the community level.     

中西医结合治疗小儿内科疾病与单一西药治疗效果对比分析

目的探究中西医结合治疗小儿内科疾病的临床疗效。方法选择2016年4月至2017年4月本院就医的98例内科疾病患儿随机分为两组,其中对照组49例,采用单一西药治疗,观察组49例,采用中西医结合治疗方式,比较两组患儿临床治疗效果。结果采用中西医结合治疗的观察组患儿治疗总有效率为95.92%,不良反应发生率为4.08%,而进行单一西医治疗的对照组患儿,治疗总有效率为87.75%,不良反应发生率为14.28%。结论中西医结合治疗小儿内科疾病不但可以提升临床治疗效果,还可以控制不良反应发生率,因此在小儿内科疾病治疗过程中,要注重中西医结合治疗方式的临床推广应用。     

中医医疗服务现状调查分析

对我国中医药服务资源的总量、结构、分布及不同机构医疗服务的提供与利用情况进行了分析.研究表明,中医药资源的总量和服务提供量均占全国医疗资源的10%左右,中医进社区具有良好的基础,资源不足影响了社区中医医疗服务的提供;综合医院中医科占有了较大资源,但效率低下.我们建议优化中医药资源配置,引导中医药专业人员向社区流动;合理定位中医医疗服务体系的功能,促进社区中医药服务的提供;充分发挥民间中医药资源的补充作用;发挥中医药的传统特色优势,促进居民更好地利用中医药服务.     

中医药在新型农村合作医疗中的价格调查分析

目的 验证中医药与西医药相比具有一定的价格优势,测算在新型农村合作医疗制度中合理提高中医药补偿比例的数值.方法 采用分层抽样调查和文献资料复习法,比较中医药、西医药及中西医结合3种方法诊治农村常见病、多发病的次均门诊和住院费用.结果 次均门诊和住院费用中,中医药低于西医药、中西医结合低于西医药、中医药低于中西医结合.其中住院费用中,中医费用比西医费用低25.2%.同时计算出了费用统计比值,提出了中医药、西医药在新型农村合作医疗中的补偿比例数学模型.结论 建议各地在制定新型农村合作医疗实施方案中,以中医药门诊和住院费用比西医药门诊和住院费用分别实行提高25%和33%左右的补偿比例为宜.     

Treatment-seeking behaviour among the Nasioi people of Bougainville: choosing between traditional and western medicine

Background. In Papua New Guinea (PNG) there continues to be considerable interest in developing a health system that incorporates both traditional and western medicine. A policy on traditional medicine has recently been endorsed. Simultaneously, there is limited information about the traditional beliefs and practices that influence treatment-seeking behaviour.

Aim of the study. A case study among the Nasioi people of Bougainville was conducted to gather information that could help to inform the implementation of the National Policy on Traditional Medicine for PNG.

Research objectives. The main objective of the case study was to describe how health knowledge and belief systems influence treatment-seeking behaviour, specifically in relation to the use of traditional and western health care systems. The study also sought to develop an explanatory model for decision-making responses to febrile illnesses and skin conditions.

Methodology. By using a non-experimental, cross-sectional study design and focused ethnographic approach, a sample of 200 Nasioi community members were interviewed by Nasioi-speaking research assistants.

Results. The study found that people in the sample group subscribe to both traditional and western medical paradigms. Western medical concepts have been assimilated but have not displaced traditional understanding of illness. There was congruence between beliefs about causes of illness, treatment-seeking responses to illness and stated or hypothetical preferences for traditional or western medicine. Data obtained in each of these domains reflect concepts of illness derived from both medical paradigms and demonstrate participants’ confidence in the efficacy of both traditional and western medicine.

Conclusions. It is proposed that a health system that incorporates traditional medicine may be better aligned with people's concepts of illness than the current system. Because it is more consistent with Nasioi concepts of illness, an incorporated health system may lead to more appropriate health service utilisation and, ultimately, to improvements in population health status.     

Disability and self-rated health among older women and men in rural Guatemala: The role of obesity and chronic conditions

Unprecedented population aging in poorer settings is coinciding with the rapid spread of obesity and other chronic conditions. These conditions predict disability and poor self-rated health and often are more prevalent in women than men. Thus, gender gaps in obesity and other chronic conditions may account for older women’s greater disability and worse self-rated health in poor, rural populations, where aging, obesity, and chronic conditions are rapidly emerging. In a survey of 604 adults 50 years and older in rural Guatemala, we assessed whether gender gaps in obesity and other chronic conditions accounted for gender gaps in disability and self-rated health. Obesity strongly predicted gross mobility (GM) disability, and the number of chronic conditions strongly predicted all outcomes, especially in women. Controlling for gender gaps in body-mass index (BMI) and especially the number of chronic conditions eliminated gender gaps in GM disability, and controlling for gender gaps in the number of chronic conditions eliminated gender gaps in self-rated health. We recommend conducting longitudinal cohort studies to explore interventions that may mitigate adult obesity and chronic conditions among poor, rural older adults. Such interventions also may reduce gender gaps in later-life disability and self-rated health.     

The health transition, global modernity and the crisis of traditional medicine: the Tibetan case

The epidemiologic and demographic consequences of the health transition, coupled with worldwide pressures for health care reform according to neoliberal tenets, will create new opportunities, and well as new problems, for organized systems of indigenous medicine. Spiraling costs of biomedically-based health care, coupled with an increasing global burden of chronic, degenerative diseases and mental disorder, will produce significant incentives for the expansion of indigenous alternatives. Yet this expansion will be accompanied by pressures to rationalize and modernize health care services according to the structurally dominant scientific paradigm. Without concerted effort to maintain native epistemologies, indigenous medical systems face an inevitable slide into narrow herbal traditions and a loss of those elements of diagnosis and therapy which may be the most valuable and effective. Analyzing the case of Tibetan medicine and other Asian medical systems, I show how this process occurs and how it is resisted. I conclude by discussing the policy dimensions of this problem.     

医学院校学生的中医药健康文化素养水平及影响因素分析

目的 了解某医学院校学生的中医药健康文化素养水平并探索其影响因素,为有针对性地提升医学生中医药健康文化素养水平提供参考依据.方法 采取分层整群抽样方法 ,对某医科大学的2600名学生采用《2017年中国公民中医药健康文化素养调查问卷》进行问卷调查,并采用Logistic回归模型探讨影响医学生中医药健康文化素养水平的因素...     

The process of social participation in primary health care: the case of Palencia,Guatemala

Background In 2008, the World Health Organization issued a callback to the principles of primary health care, which renewed interests in social participation in health. In Guatemala, social participation has been the main policy for the decentralization process since the late 1990s and the social development council scheme has been the main means for participation for the country’s population since 2002. Aim The aim of this study was to explore the process of social participation at a municipal‐level health commission in the municipality of Palencia, Guatemala. Methods Analysis of legal and policy documents and in‐depth interviews with institutional and community‐level stakeholders of the commission. Results The lack of clear guidelines and regulations means that the stakeholders own motivations, agendas and power resources play an important part in defining the roles of the participants. Institutional stakeholders have the human and financial power to make policies. The community‐level stakeholders are token participants with little power resources. Their main role is to identify the needs of their communities and seek help from the authorities. Satisfaction and the perceived benefits that the stakeholders obtain from the process play an important part in maintaining the commission’s dynamic, which is unlikely to change unless the stakeholders perceive that the benefit they obtain does not outweigh the effort their role entails. Conclusion Without more uniformed mechanisms and incentives for municipalities to work towards the national goal of equitable involvement in the development process, the achievements will be fragmented and will depend on the individual stakeholder’s good will.     

中医医院临床诊断有关中西医病名的浅析

目的进行中西医双重诊断相关性研究,折射出病案书写和诊断水平的情况,为加强医疗质量管理提供借鉴。方法对全国中医医院医疗质量监测的100所中医医院,自2002--2005年4年的涉及呼吸、肾病、血液、肝病、妇科、肛肠、骨伤7个类别的37万余份出院病案首页,进行中西医双重诊断相关性研究。结果中西医诊断相符的病例有292707,中西医诊断不相符的病例有20455,中西医诊断存疑的病例有62228,中西医病名诊断规范化需要加强。结论我们必须加强中医医院的病案质量管理工作。     

A quackery with a difference-new medical pluralism and the problem of 'dangerous practitioners' in the United Kingdom

The figure of the 'miracle cure'-peddling quack pretending spectacular properties for worthless tonics is iconic. From their 19th century traveling wagon shows to their 21st century Internet spam scams, hucksters and cranks have been consistently targeted by health authorities as a danger to public health. Yet, in this paper, I argue that this is only one form that the problem of 'quackery' has taken in the past two centuries or so in the United Kingdom. Just as Roy Porter showed how the mid-19th century professionalization of medicine gave rise to a 'quackery with a difference' as a whole range of new medical movements-homoeopathy, hydropathy, medical botany, mesmerism-actively denounced allopathic or modern medicine, I will suggest that the late 20th century birth of 'complementary and alternative medicine' (CAM) has resulted in yet another transformation in quackery. By examining the ways in which regulatory authorities in the UK have come to address what is invariably described as a 'growing interest in CAM', I will show how the problem of quackery today is increasingly located in an ethical field of practitioner competency, qualifications, conduct, responsibility and personal professional development, almost (but not quite) regardless of the form of therapy in question.     

医学科教新任务——促进转化医学

近年来基础医学研究发展迅速,耗费不断增高,但是基础医学研究成果能够形成转化的却很少,对临床研究起到推动作用的就更少,因此,在基础研究与临床研究之间形成了一条严重制约医学科技进步和阻碍人民大众健康水平提高的“鸿沟”。为了消除基础研究与临床研究之间的“鸿沟”,转化医学应运而生,它作为新生的学科,正在被各国学者认识和应用。本文在总结和归纳了现有有关转化医学研究的一些特点和新进展的基础上,结合我国医疗改革的现状和医院科教工作的特点,提出了加强我国转化医学研究的新思路,以缓解政府、社会、民众对医学科学发展“错配”局面的不满,开创和谐医学科技发展的新局面。     

中药药物代谢动力学的研究进展

本文就单味中药和复方中药在指标性成分、有效成分、药效学、药动学等方面进行分析与探讨,可尝试将将一些新型技术运用到中药药动学的研究中使中药药动学向更深、更广的层面拓展,为中药药动学及中药药效物质基础的深入研究提供参考。     

Views on traditional Chinese medicine amongst Chinese population: a systematic review of qualitative and quantitative studies

Background

Health‐care professionals worldwide have started to appreciate patients'' perspectives on the use of complementary and alternative medicine (CAM) particularly given its popularity. However, cultural perspectives may vary and it may not be possible to apply research findings on the use of CAM from the west to the east.

Objective

This systematic review aims to synthesize usage patterns of traditional Chinese medicine (TCM) amongst Chinese populations in different parts of the world and explore potential geographical variations.

Search strategy

Six international and four Chinese databases were searched, and manual searches of relevant monographs and government publications were carried out.

Inclusion criteria

Quantitative, qualitative or mixed‐method research that aimed to investigate Chinese patients'' perception of, and perspectives on, TCM was included.

Data extraction and synthesis

For each study included, texts under the headings of ‘results’ or ‘findings’ were extracted and subjected to analysis. A thematic synthesis approach was adopted for synthesizing qualitative and quantitative studies.

Main results

Amongst the 28 studies included, twenty were quantitative surveys, six were qualitative studies and two were mixed‐method studies. The overall methodological quality was mediocre. Data synthesis suggested that patients from all regions share a common cultural affinity to TCM and consider it to be an effective complement to western medicine (WM) for treating chronic or serious diseases. However, heterogeneous views on (i) disclosing TCM use to WM doctors and (ii) the potential harm of herbs emerged across different study locations.

Discussion and conclusions

Future research should explore how variation in health systems may influence patients'' perception of CAM in different countries.     

论药理学在中等中医专业的教学方法

药理学是桥梁科学,本文就三年制中等中医专业药理学的教学问题进行了探讨,其主要观点是:重视理论、讲好第一堂课;精选内容、各有侧重;结合临床,加强记忆;适当补充中药药理学知识;加强课堂提问,开展课堂讨论;作好小结,加深理解.     

从卫生服务供方意向调查的变迁看中医发展危机

为了进一步了解中医的发展状况，通过对2008年与2000年样本地区卫生服务供方的意向调查数据的比较，分析卫生服务供方对中医信仰的变迁。研究发现，卫生服务供方对中医信仰进一步降低，中医成为西医的简单补充。在这种情况下，如何把握中医特色，创新诊疗手段，总结推广中医特效治疗种类和范围，推广适宜技术等尤为重要，逐步提高卫生服务供方对于中医的支持和认可。