Traditional medicine use by cancer patients in Thailand

Ethnobotanical relevance Cancer patients commonly use traditional medicines (TM) and in Thailand these are popular for both self-medication and as prescribed by TM practitioners, and are rarely monitored. A study was conducted at Wat Khampramong, a Thai Buddhist temple herbal medicine hospice, to document some of these practices as well as the hospice regime. Materials and methods Cancer patients (n=286) were surveyed shortly after admission as to which TMs they had previously taken and perceptions of effects experienced. They were also asked to describe their current symptoms. Treatment at the hospice is built upon an 11-herb anti-cancer formula, yod-ya-mareng, prescribed for all patients, and ideally, its effects would have been evaluated. However other herbal medicines and holistic practices are integral to the regime, so instead we attempted to assess the value of the patients׳ stay at the hospice by measuring any change in symptom burden, as they perceived it. Surviving patients (n=270) were therefore asked to describe their symptoms again just before leaving. Results 42% of patients (120/286; 95% CI 36.4%, 47.8%) had used herbal medicines before their arrival, with 31.7% (38/120; 95% CI 24%, 40.4%) using several at once. Mixed effects were reported for these products. After taking the herbal regime at Khampramong, 77% (208/270 95% CI; 71.7%, 81.7%) reported benefit, and a comparison of the incidence of the most common (pain, dyspepsia, abdominal or visceral pain, insomnia, fatigue) showed statistical significance (χ2 57.1, df 7, p<0.001). Conclusions A wide range of TMs is taken by cancer patients in Thailand and considered to provide more benefit than harm, and this perception extends to the temple regime. Patients reported a significant reduction in symptoms after staying at Khampramong, indicating an improvement in quality of life, the aim of hospices everywhere. Based on this evidence, it is not possible to justify the use of TM for cancer in general, but this study suggests that further research is warranted. The uncontrolled use of TMs, many of which are uncharacterised, raises concerns, and this work also highlights the fact that validated, robust methods of assessing holistic medical regimes are urgently needed.

Teacher self-perceptions of effectiveness: a study in a district of Kenya

Background and purpose: The paper reports a study of the perceptions of teachers in secondary schools in the Gucha district of Kenya of their own effectiveness, the structure of their self-perceptions, variations in self-perceived effectiveness and the relationship between self-perceptions of effectiveness and the examination performance of their students. Design and methods: Data were based on questionnaires completed by 109 English and mathematics teachers from a random sample of 30 schools in the Gucha district of Kenya. Pupil examination results were also collected from the schools. Results: Three dimensions of self-perceived effectiveness emerged from a factor analysis. These were: pedagogic process, personal and affective aspects of teaching and effectiveness with regard to pupil performance. Teachers tended to rate themselves relatively highly with regard to the first two, process-oriented, dimensions but less highly on the third, outcome-oriented, dimension. Self-ratings for pupil outcomes correlated with pupil examination performance at school level. Conclusions: The results show that these teachers can have a sense of themselves as competent classroom performers and educational professionals without necessarily having a strong sense of efficacy with regard to pupil outcomes.

Exploring behavioural change through an agent-oriented system dynamics model: the use of personal protective equipment among pesticide applicators in Colombia

The misuse of Personal Protective Equipment results in health risk among smallholders in developing countries, and education is often proposed to promote safer practices. However, evidence point to limited effects of education. This paper presents a System Dynamics model which allows the identification of risk-minimizing policies for behavioural change. The model is based on the IAC framework and survey data. It represents farmers' decision-making from an agent-oriented standpoint. The most successful intervention strategy was the one which intervened in the long term, targeted key stocks in the systems and was diversified. However, the results suggest that, under these conditions, no policy is able to trigger a self sustaining behavioural change. Two implementation approaches were suggested by experts. One, based on constant social control, corresponds to a change of the current model's parameters. The other, based on participation, would lead farmers to new thinking, i.e. changes in their decision-making structure.