Institutionalization of African traditional medicine in health care systems in Africa

In recent times, the phrase " traditional medicine" has become a catchword among the peoples in all countries in Africa. This has been due partly because the use of herbal remedies has gained popularity worldwide and the exploitation of these remedies has become a multimillion industry. The term "African traditional medicine" is not synonymous with "Alternative and complimentary medicine" which is a misnomer which is sometimes used. African traditional medicine is the African indigenous system of health care and therefore cannot be an alternative. In Africa, there is an important reason why African traditional medicine has become increasingly popular. The high cost of allopathic medical health care and the expensive pharmaceutical products have become unavailable to a majority of people. Naturally, the many centuries-old alternative sources of health care have become handy, often in desperate situations. In fact, the frequently quoted statement that 85 per cent of the people in Africa use traditional medicine, is an understatement because this figure is much higher and continues to increase. At the Alma Atta Declaration of 1978, it was resolved that traditional medicine had to be incorporated in the health care systems in developing countries if the objective of the "Health for All by the Year 2000" was to be realized. Notwithstanding this strategy, African countries did not come near the objective at the end of the 20th century. Therefore, the Member States of the WHO African Region adopted a resolution in 2000 called "Promoting the role of traditional medicine in health care systems: A strategy for the African Region". This strategy provides for the institutionalization of traditional medicine in health care systems of the member states of the WHO African Region. Furthermore, the OAU (African Union) Heads of State and Government declared the period 2000 - 2010 as the African Decade on African Traditional Medicine. In addition, the Director General of the World Health Organization also declared 31st August every year as African Traditional Medicine Day. All these declarations signify the importance and the approval by Governments and international institutions of the need to institutionalize African traditional medicine in health care. Therefore the mechanisms for institutionalization have to be developed to make these resolutions a reality. In view of the complexity and heterogeneity of African traditional medicine, a system of incorporation in the current health care systems has to be developed. During the last four years the WHO Regional Director for Africa and his Secretariat took up the challenge and have developed model guidelines that the Member States can adapt or adopt as may be appropriate in the respective Member States. Some of the relevant guidelines include the following: 1. Guidelines for the formulation, implementation, monitoring and evaluation of a National Traditional Medicine Policy 2. Model legal framework for the practice of traditional medicine: The Traditional Health Practitioners Bill; 3. Model Codes of Ethics for Traditional Health Practitioners 4. A Regional framework for the registration of traditional medicines in the WHO African Region; 5. A regulatory framework for the protection of intellectual property rights (IPR) and indigenous knowledge of traditional medicines in the WHO African Region. These guidelines and others provide a basis for the incorporation of African traditional medicine in a manner that would best suit a particular country. The WHO Regional Director for Africa also appointed a Regional Expert Committee on Traditional Medicine which assists in the development of these guidelines. It is important to emphasize that as more and more people use this traditional health care facility, there is an urgent need for the appropriate systems of quality control in the practice as well as in the production and use of the medicines. Such systems will protect the public and also ensure that the best practices and the most useful medicines are made available in the most affordable manner. Every country in the African region would be expected to adopt a method of incorporation that would be suitable: integrative, inclusive, or tolerant, as the case may be. It is an undeniable fact that we cannot afford to sit on the fence. All the stakeholders stand to gain a great deal in the development and promotion of African traditional medicine. In particular, all the practitioners in the present allopathic health care system will gain professionally as well as economically as they will have access to an additional culture-friendly system with which to provide services to the people. All the stakeholders must join hands in the effort to institutionalize the appropriate African traditional medicine in the health care systems in order to provide the health services that are urgently needed in the communities.     

Effect of employment on quality of life and psychological functioning in patients with HIV/AIDS

The need to address the role of employment in the psychosocial adjustment of persons with HIV/ AIDS has been consistently recognized in the clinical care and research literature. In this study, 200 volunteer HIV/AIDS patients completed questionnaires assessing medical and vocational histories, quality of life, and psychological functioning. Employed and unemployed participants did not significantly differ in terms of gender, education level, ethnicity, prevalence of diagnosed psychiatric and substance use disorders, or overall level of psychological functioning. However, with HIV illness severity statistically controlled, employed participants reported significantly higher overall quality of life.     

HIV感染者/AIDS病人生存质量现状及相关因素研究

目的了解HIV感染者/AIDS病人生存质量的现状并分析其相关因素。方法应用世界卫生组织生存质量量表（WHOQOL-BREFF）中文版评价HIV感染者及AIDS病人的生存质量,同时调查可能影响生存质量的人口学特征、HIV感染有关情况和社会支持等。采用t检验、方差分析进行单因素分析,多元线性回归模型分析生理、心理、社会关系及环境4大领域的影响因素。结果 112例HIV感染者/AIDS病人生存质量4大领域平均得分分别为：生理领域（60.5±16.2）分、心理领域（51.8±17.5）分、社会关系领域（58.1±19.3）分,环境领域（47.5±15.6）分。各维度得分均低于全国常模,差异有统计学意义（P〈0.05）。主观支持得分越高,HIV感染者/AIDS病人生存质量4个领域得分就越高;静脉吸毒途径感染的HIV感染者/AIDS病人生理领域总分低于性途径感染者;有工作/学习的HIV感染者/AIDS病人生理和心理领域得分高于无业者;对支持利用度高者,其心理领域得分也高;在环境领域得分中,患者文化程度越高,其得分越高。结论应加强失业、文化程度低、抗病毒治疗患者、静脉注射感染者以及社会支持差者的心理健康辅导,以提高其生存质量。     

Western medicine and traditional healers: partners in the fight against HIV/AIDS

Prevention and control programs for HIV/AIDS have had limited success, especially in sub-Saharan Africa. Not surprising, most residents see traditional healers as their only option to meet their healthcare needs. Some patients refuse surgery or other medical treatment unless their traditional healer sanctions the treatment first. Formally trained doctors have finally begun to consider traditional healers as potential allies in the battle to prevent the spread of HIV/AIDS by recognizing that the longstanding trust and credibility of these healers in the black communities can facilitate change in sexual behavior. Innovative and effective approaches, including utilization of traditional healers, can play a vital role in Africa's AIDS prevention and control programs.     

中药与西药对照治疗偏头痛的Meta分析

目的评价中药治疗偏头痛的临床疗效和安全性。方法计算机检索中国期刊全文数据库、维普中文期刊数据库、万方学术期刊全文数据库、中国生物医学文献服务系统（CBM）、中国生物医学期刊引文数据库（CMCI/CMCC整合版）、中医药在线数据库,检索2000年1月—2009年12月10年间的相关文献,收集中药治疗偏头痛的随机对照试验（RCTs）。按纳入排除标准筛选试验、评价研究质量、提取有效数据,并采用RevMan5.0进行统计分析。结果最终纳入20个RCT评价中药与西药在偏头痛疗效方面的差异,Meta分析显示：有效率[RR=1.22,95%CI（1.15,1.29）,P〈0.01],差异有统计学意义。敏感性分析表明评价结果稳定。漏斗图显示不对称,提示纳入评价的文献存在发表性偏倚。结论中药治疗偏头痛有效,但由于本系统评价纳入研究的方法学质量较低,尚需开展更多设计合理、执行严格的多中心大样本且随访时间足够长的随机对照试验验证其疗效及安全性。     

Assessment of factors associated with the quality of life of patients living with HIV/HCV co-infection

This study compared the quality of life (QoL) of HIV-infected patients with and without hepatitis C and examined the sociodemographic, HIV-related and psychological symptoms associated with the QoL domains in patients with HIV/HCV co-infection. The sample consisted of 248 HIV/HCV co-infected patients (18–74 years, 81.5 % male) and 482 patients only with HIV (24–78 years, 62.7 % male). Participants completed the WHOQOL-HIV-Bref questionnaire and the Brief Symptom Inventory. The HIV/HCV co-infected patients reported significantly lower QoL in all domains, as well as significantly lower scores in 10 of the 17 specific facets. Overall, among the co-infected patients, male gender, employment, combination antiretroviral therapy use and fewer depressive and anxiety symptoms were significantly associated with higher QoL. Symptoms of psychological distress accounted for significant variability in the QoL scores of co-infected patients. These data reinforce the need for tailored interventions to improve the overall well-being of HIV/HCV co-infected patients.     

中西医结合治疗多囊卵巢综合征不孕症63例分析

目的多囊卵巢综合征(PCOS),以持续不排卵和高雄性激为根本特征的一种常见妇科内分泌疾病。临床表现为月经不调、不孕、多毛、肥胖和卵巢囊性增大的综合征。方法本文将在本院妇科门诊患者分成两组,对照组37例,采用纯西医治疗,治疗组63例,在上基础上配合中药治疗。结果对照组受孕率29.73%,治疗组受孕率66.67%,差异有显著性意义。结论采用中西医结合方法治疗多囊卵巢不孕症能提高患者的妊娠率。     

Incorporating quality of life measures in HIV clinical trials

Abstract

PURPOSE: To increase awareness regarding issues specific to health-related quality of life (HRQL) assessments for investigators designing clinical trials and for clinicians reading published reports on clinical trials. HQRL measures are becoming more prevalent, alongside conventional therapeutic and laboratory endpoints. However, they differ from these physiologic or biologic measurements because HRQL data are subjective. We discuss the criteria for selecting and implementing HRQL instruments to optimize the usefulness of HRQL assessments in clinical studies. METHOD: We conducted a review of selected design and measurement issues that should be considered when planning for the use of HRQL instruments in HIV/AIDS clinical trials. CONCLUSION: When used appropriately, HRQL measures can indicate the impact of HIV treatment on patient functioning and well-being and can help to inform clinicians about treatment effects.     

异位妊娠的诊断及中西医治疗进展

正常妊娠时，孕卵着床于子宫体腔内膜，当孕卵在子宫体腔以外的部位着床发育称为异位妊娠，习惯上称为宫外孕。根据孕卵着床部位不同，可分为输卵管妊娠、腹腔妊娠、卵巢妊娠、宫颈妊娠等，其中以输卵管妊娠最常见，育龄女性均可发病。本文就输卵管妊娠的病因、临床表现、以及诊治等方面的进展综述如下。     

A comparison of smoking cessation efforts in African Americans by resident physicians in a traditional and primary care internal medicine residency

Tobacco use causes significant morbidity and mortality among African Americans. Physicians may inconsistently counsel patients against smoking. This retrospective chart review evaluated smoking cessation efforts in African Americans by internal medicine resident physicians in a traditional and a primary care residency program. One hundred twenty-nine African-American patients were evaluated by resident physicians in the traditional internal medicine residency. A tobacco use history was obtained in 84 patients. Twenty-eight patients smoked and two patients were counseled against smoking. Fifty-two African-American patients were evaluated by resident physicians in the primary care residency. A tobacco use history was obtained in 47 patients. Twenty patients smoked and 12 patients were counseled against smoking. There was a statistically significant difference in the rate at which smoking histories were obtained (p = 0.0011) and frequency of counseling against smoking (p < 0.0001). Gender analysis revealed that African-American women were less frequently asked about their smoking history (p = 0.0058) and counseled against smoking (p = 0.0016) by resident physicians in the traditional residency. African-American men received less counseling against smoking (p = 0.055) by resident physicians in the traditional residency. Resident physicians in the primary care residency program demonstrated greater smoking cessation efforts for African American patients. Smoking cessation should be emphasized in all internal medicine residency training programs.     

中西医结合治疗对SARS患者淋巴细胞及T细胞亚群的影响

目的分析中西医结合疗法对SARS患者淋巴细胞及T细胞亚群CD3+、CD4+/CD8+的影响,探讨其对调节机体免疫功能的作用.方法将该院48例SARS确诊患者随机分为中西医结合组及西医组.西医组采用西医治疗方案,结合组采用中西医结合治疗方案.根据病情中西医结合治疗组患者服用中药3周,治疗前后分别测定患者外周血淋巴细胞及T细胞亚群CD3+、CD4+/CD8+.外周血淋巴细胞采用日本sysmexk-4500全自动血细胞分析仪检测分析,T细胞亚群CD3+、CD4+/CD8+系采用荧光技术、流式细胞仪检测.结果①治疗前所有患者中有38例血淋巴细胞绝对值低下,所测38例患者中有19名患者CD3+及CD4+/CD8+百分比降低.②结合组血淋巴细胞绝对值在治疗前平均值为1.00×109±0.46×109 L-1,西医组为1.26×109±0.59×109 L-1,治疗后分别为1.92×109±0.74×109 L-1和1.76×109±0.52×109 L-1,治疗前后比较均有显著性差异(P＜0.01).结合组治疗前后差值显著高于西医组(P＜0.01).③在治疗前CD3+异常低下19例中,结合组有9例,西医组有10例,经治疗后仍低于正常分别有2例和8例.治疗前CD4+/CD8+异常低下共28例,结合组及西医组分别有15例和13例,经治疗后仍低于正常分别有5例和10例;经Fisher精确检验后表明在促进T细胞亚群的恢复方面中西医结合治疗方案要明显优于单纯西医治疗方案(P＜0.05).结论SARS患者存在有细胞免疫功能的障碍,采用中西医结合治疗在减轻淋巴细胞的抑制状态、提高T细胞亚群水平,从而增强机体免疫力作用方面明显优于单纯西医治疗.     

PBL在中西医结合眼科学教学中的体会

PBL(Problem-based learning,PBL)教学法是指在临床前期或临床教学中,以临床典型病案为基础,以学生为中心的小组讨论式教学方法[1].我科开展PBL教学模式以来,结合实际情况,总结出带有目标的PBL教学模式的理论教学结合实习课中病例讨论的教学方法,收到了良好的效果,现报告如下.