Can Andean medicine coexist with biomedical healthcare? A comparison of two rural communities in Peru and Bolivia

Background It is commonly assumed that indigenous medical systems remain strong in developing countries because biomedicine is physically inaccessible or financially not affordable. This paper compares the health-seeking behavior of households from rural Andean communities at a Peruvian and a Bolivian study site. The main research question was whether the increased presence of biomedicine led to a displacement of Andean indigenous medical practices or to coexistence of the two healing traditions. Methodology Open-ended interviews and free listing exercises were conducted between June 2006 and December 2008 with 18 households at each study site. Qualitative identification of households’ therapeutic strategies and use of remedies was carried out by means of content analysis of interview transcriptions and inductive interference. Furthermore, a quantitative assessment of the incidence of culture-bound illnesses in local ethnobiological inventories was performed. Results Our findings indicate that the health-seeking behavior of the Andean households in this study is independent of the degree of availability of biomedical facilities in terms of quality of services provided, physical accessibility, and financial affordability, except for specific practices such as childbirth. Preference for natural remedies over pharmaceuticals coexists with biomedical healthcare that is both accessible and affordable. Furthermore, our results show that greater access to biomedicine does not lead to less prevalence of Andean indigenous medical knowledge, as represented by the levels of knowledge about culture-bound illnesses. Conclusions The take-home lesson for health policy-makers from this study is that the main obstacle to use of biomedicine in resource-poor rural areas might not be infrastructural or economic alone. Rather, it may lie in lack of sufficient recognition by biomedical practitioners of the value and importance of indigenous medical systems. We propose that the implementation of health care in indigenous communities be designed as a process of joint development of complementary knowledge and practices from indigenous and biomedical health traditions.

Physicians' philosophy of care: a comparison of complementary and conventional medicine

BACKGROUND: This project is part of an evaluation of complementary and alternative medicine (CAM) aimed at providing a scientific basis for the Swiss Government to include 5 CAM methods in basic health coverage: anthroposophic medicine, homeopathy, neural therapy, phytotherapy and Traditional Chinese Medicine (TCM). OBJECTIVES: The objective was to explore the philosophy of care (convictions and values, priorities in medical activity, motivation for CAM, criteria for the practice of CAM, limits of the used methods) of conventional and CAM general practitioners (GPs) and to determine differences between both groups. MATERIALS AND METHODS: This study was a cross-sectional survey of a representative sample of 623 GPs who provide complementary or conventional primary care. A mailed questionnaire with open-ended questions focusing on the philosophy of care was used for data collection. An appropriate methodology using a combination of quantitative and qualitative approaches was developed. RESULTS: Significant differences between both groups include philosophy of care (holistic versus positivistic approaches), motivation for CAM (intrinsic versus extrinsic) and priorities in medical activity. Both groups seem to be aware of limitations of the therapeutic methods used. The study reveals that conventional physicians are also using complementary medicine. DISCUSSION: Our study provides a wealth of data documenting several aspects of physicians' philosophy of care as well as differences and similarities between conventional and complementary care. Implications of the study with regard to quality of care as well as ethical and health policy issues should be investigated further.

Formal speech stylistics and type A behavior in 38 subjects during nonstress interviews

Open-ended interviews of 90 min length of 38 patients were analyzed with respect to speech stylistics, shown by Schucker and Jacobs to differentiate individuals with type A personality features from those with type B. In our patients, Type A/B had been assessed by the Bortner Personality Inventory. The stylistics studied were: repeated words swallowed words, interruptions, simultaneous speech, silence latency (between question and answer) (SL), speed of speech, uneven speed of speech (USS), explosive words (PW), uneven speech volume (USV), and speech volume. Correlations between both raters for all speech categories were high. Positive correlations between extent of type A and SL (r = 0.33; p = 0.022), USS (r = 0.51; p = 0.002), PW (r = 0.46; p = 0.003) and USV (r = 0.39; p = 0.012) were found. Our results indicate that the speech in nonstress open-ended interviews of type A individuals tends to show a higher emotional tension (positive correlations for USS PW and USV) and is more controlled in conversation (positive correlation for SL).

Assessment of a high school geological field course

Fieldwork is supportive of students’ natural inquiry abilities. Educational research findings suggest that instructors can foster the growth of thinking skills and promote science literacy by incorporating active learning strategies (McConnel et al, 2003). Huntoon (2001) states that there is a need to determine optimal learning strategies and to document the procedure of assessing those optimal geoscience curricula. This study seeks to determine if Earth Space II, a high school geological field course, can increase students’ knowledge of selected educational objectives. This research also seeks to measure any impact Earth Space II has on students’ attitude towards science. Assessment of the Earth Space II course objectives provided data on the impact of field courses on high school students’ scientific literacy, scientific inquiry skills, and understanding of selected course objectives. Knowledge assessment was done using a multiple choice format test, the Geoscience Concept Inventory, and an open-ended format essay test. Attitude assessment occurred by utilizing a preexisting science attitude survey. Both knowledge assessments items showed a positive effect size from the pretest to the posttest. The essay exam effect size was 17 and the Geoscience Concept Inventory effect size was 0.18. A positive impact on students’ attitude toward science was observed by an increase in the overall mean Likert value from the pre-survey to the post-survey.

An ethnobotanical survey of the economic and cultural significance of non-timber forest products in the southwest Rhodope Mountain region of Bulgaria

The people of the southwestern Rhodope Mountains of Bulgaria live in small, mountainous villages and rural areas. They rely on berries, herbs, and mushrooms provided by the forest and maintain a lifestyle and culture of gathering them. This study determined the economic and landscape concentration of Non-Timber Forest Products (NTFPs) and how this has changed in the past twenty years in the region of Garmen. The objective was to gauge the cultural and economic significance of NTFPs in the lives of the people who live there. Data was collected using informal, open-ended interviews and through participant observation. Results indicate that ethnicity influence how resources are utilized. Roma people collect mushrooms for income generation; Orthodox Bulgarians gather herbs, berries, and mushrooms for medicinal purposes, to supplement their diets, and to carry on traditions. Bulgarian Muslims collect for a combination of the aforementioned reasons. Changes that occur in the forests affect each of the ethnic groups in different ways and forest management practices should include people’s knowledge and uses of NTFPs.

Social Workers Involvement in Taiwan's 1999 Earthquake Disaster Aid: Implications for Social Work Education

On September 21, 1999, a strong earthquake devastated Taiwan's central areas and claimed more than two thousand casualties. Social work roles in the disaster aid were surveyed with standardized questionnaires six months after the earthquake; in addition, interviews of the key informants, documental research, focus groups and open-ended questionnaires were utilized to collect qualitative data. The study found that social workers had significant roles and functions in both rescue and recovery stages especially in linking the victims' needs with resources. Social workers, including from public and private sectors as well as from campuses including the faculties and students of social work departments, have been deeply involved in helping the victims. Regrettably, most Taiwanese social workers participated in the rescue aid with limited training in disaster aid; social work practice in disaster aid is not included in current curriculums of college level. This means that social work roles and functions in the disaster aid process have not been fully realized by Taiwan's society and professional education.

The International Three-Step Test. A Model Provision for EC Fair Use Legislation

The three-step test is central to the regulation of copyright limitations at the international level. Delineating the room for exemptions with abstract criteria, the three-step test is by far the most important and comprehensive basis for the introduction of national use privileges. It is an essential, flexible element in the international limitation infrastructure that allows national law makers to satisfy domestic social, cultural, and economic needs. Given the universal field of application that follows from the test’s open-ended wording, the provision creates much more breathing space than the more specific exceptions recognized in international copyright law. EC copyright legislation, however, fails to take advantage of the flexibility inherent in the three-step test. Instead of using the international provision as a means to open up the closed EC catalogue of permissible exceptions, offer sufficient breathing space for social, cultural, and economic needs, and enable EC copyright law to keep pace with the rapid development of the Internet, the Copyright Directive 2001/29/EC encourages the application of the three-step test to further restrict statutory exceptions that are often defined narrowly in national legislation anyway. In the current online environment, however, enhanced flexibility in the field of copyright limitations is indispensable. From a social and cultural perspective, the web 2.0 promotes and enhances freedom of expression and information with its advanced search engine services, interactive platforms, and various forms of user-generated content. From an economic perspective, it creates a parallel universe of traditional content providers relying on copyright protection, and emerging Internet industries whose further development depends on robust copyright limita- tions. In particular, the newcomers in the online market – social networking sites, video forums, and virtual worlds – promise a remarkable potential for economic growth that has already attracted the attention of the OECD. Against this background, the time is ripe to debate the introduction of an EC fair use doctrine on the basis of the three-step test. Otherwise, EC copyright law is likely to frustrate important opportunities for cultural, social, and economic development. To lay groundwork for the debate, the differences between the continental European and the Anglo-American approach to copyright limitations (section 1), and the specific merits of these two distinct approaches (section 2), will be discussed first. An analysis of current problems that have arisen under the present dysfunctional EC system (section 3) will then serve as a starting point for proposing an EC fair use doctrine based on the three-step test (section 4). Drawing conclusions, the international dimension of this fair use proposal will be considered (section 5).

Patientensicherheit in der Hausarztpraxis

Einleitung Aus der Schweizer Grundversorgung lagen bisher noch keine systematischen Daten zu kritischen Ereignissen und zum Sicherheitsklima vor. Aus diesem Grund wurde eine Befragung von Ärzten und Medizinischen Praxisassistentinnen (MPA) in Deutschschweizer Hausarztpraxen sowie ein Folgeprojekt spezifisch zur Telefon-Triage durchgeführt. Methoden Mit Hilfe eines standardisierten Fragebogens wurden Fachpersonen in Hausarztpraxen zu Sicherheitsrisiken und zum Sicherheitsklima in ihren Praxen befragt. Der Fragebogen enthielt neben Fragen zum Sicherheitsklima Beschreibungen von 23 kritischen Ereignissen in Hausarztpraxen, die bezüglich Häufigkeit des Auftretens in der Praxis in den vergangenen zwölf Monaten sowie der Schadensfolge beurteilt wurden, als das Ereignis zum letzten Mal in der Praxis aufgetreten ist. Zudem beantworteten Ärzte und MPA eine offene Frage, nach den für sie besonders relevanten Risiken für die Patientensicherheit in ihren Praxen. Im Folgeprojekt wurden Interviews und Gruppendiskussionen mit MPA und Ärzten geführt, um eine Prozessanalyse der Telefon-Triage durchzuführen und ein Hilfsmittel für Hausarztpraxen zur Stärkung einer sicheren Telefon-Triage zu entwickeln. Ergebnisse 630 Ärzte und MPA (50,2% Ärzte, 49,8% MPA) haben an der Studie teilgenommen. 30% der Ärzte und 17% der MPA gaben an, mindestens einen der untersuchten Ereignisse täglich oder wöchentlich in ihrer Praxis zu beobachten. Fehler bei der Dokumentation wurden am häufigsten beobachtet. Ereignisse, die sich aufgrund der Schadensfolge als besonders relevant erwiesen, waren Fehleinschätzungen bei Kontaktaufnahmen der Patienten mit der Praxis, Diagnosefehler, mangelnde Überwachung von Patienten nach therapeutischen Massnahmen und Fehler in Zusammenhang mit der Medikation. Die Medikation (28% der Nennungen), medizinische Verrichtungen in der Praxis (11%) und die Telefon-Triage (7%) wurden am häufigsten als die Risiken genannt, die die Studienteilnehmer in ihren Praxen gerne eliminieren würden. In Bezug auf das Sicherheitsklima erwiesen sich insbesondere Teamsitzungen und regelmässige Qualitätszirkel-Teilnahme als relevante Prädiktoren für die Dimension „Teambasierte Aktivitäten und Strategien zur Fehlerprävention“. Berufsgruppenunterschiede zwischen Ärzten und MPA konnten sowohl hinsichtlich der berichteten Sicherheitsrisiken, als auch beim Sicherheitsklima beobachtet werden. Fazit Die Ergebnisse der Studie legen die Telefon-Triage als bislang wenig beachteten jedoch sehr relevanten Sicherheitsbereich in der Grundversorgung dar. Um die Sicherheit der Telefon-Triage zu stärken, wurde ein Anschlussprojekt durchgeführt, aus dem heraus ein Leitfaden für Hausarztpraxen entwickelt wurde. Dieser Leitfaden soll Ärzte und MPA in einer gemeinsamen und kritischen Auseinandersetzung von Strukturen und Prozessen rund um die Telefon-Triage sowie der Entwicklung von Verbesserungsschritten unterstützen. Die systematisch beobachteten Berufsgruppenunterschiede sind ein wichtiger Hinweis dafür, dass das gesamte Praxisteam in die Analyse von Sicherheitsrisiken und die Entwicklung von Massnahmen einbezogen werden sollte. Nur so können Risiken umfassend erfasst und für alle Fachpersonen relevante und getragene Verbesserungen initiiert werden. Dieser Ansatz der Team-Involvierung bildet die Basis für den Praxisleitfaden zur Telefon-Triage.

Explanations for unsuccessful weight loss among bariatric surgery candidates.

BACKGROUND: Our objective was to analyze subjective explanations for unsuccessful weight loss among bariatric surgery candidates. METHODS: This was a retrospective analysis of 909 bariatric surgery candidates (78.2% female, average body mass index [BMI] 47.3) at a university center from 2001 to April 2007 who answered an open-ended question about why they were unable to lose weight. We generated a coding scheme for answers to the question and established inter-rater reliability of the coding process. Associations with demographic parameters and initial BMI were tested. RESULTS: The most common categories of answers were nonspecific explanations related to diet (25.3%), physical activity (21.0%), or motivation (19.7%), followed by diet-related motivation (12.7%) and medical conditions or medications affecting physical activity (12.7%). Categories related to time, financial cost, social support, physical environment, and knowledge occurred in less than 4% each. Men were more likely than women to cite a medical condition or medication affecting physical activity (19.2% vs 10.8%, P = 0.002, odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.28-2.99) but less likely to cite diet-related motivation (7.1% vs 14.2%, P = 0.008, OR = 0.46, 95% CI = 0.26-0.82). CONCLUSIONS: Our findings suggest that addressing diet, physical activity, and motivation in a comprehensive approach would meet the stated needs of obese patients. Raising patient awareness of under-recognized barriers to weight loss, such as the physical environment and lack of social support, should also be considered. Lastly, anticipating gender-specific attributions may facilitate tailoring of interventions.

Coordination of Family Preservation Services in a Rural Community: A Case Study

Family preservation programs designed to prevent the out-of-home placement of children depend on the coordination of services from multiple agencies. Little is known regarding how coordination occurs. This case study examined this issue. Information was sought from all workers who provided services to each of five families and 'from families' case records. Thirty-one workers were interviewed with a semi-structured interview schedule containing rating scales and questions with open-ended response formats. Case records were reviewed with a case record review form. Analyses of data revealed the following. Services were coordinated to a moderate degree but that coordination deteriorated over time. Workers elaborated how aspects of communities, human service agencies, workers, and families affected coordination. Implications of findings for future research were drawn.

Umstrukturierung von kollektiven Kapitalanlagen

The issuance of the Swiss Federal Act on Collective Investment Schemes (CISA) in the year 2007 and the revision thereof in 2013 expanded the possibilities for restructuring of collective investment schemes and simplified the procedures. For instance, in article 95 the CISA contains a provision that deals in a non-conclusive way with the restructuring of open-ended collective investment schemes. As a novelty regulation, this provision allows for mergers not only of contractual funds but also of investment companies with variable capital (SICAV). Additionally, the transformation of an open-ended collective investment into another CISA legal form was also included into the catalogue of possible restructuring processes. Further, a SICAV still maintains the possibility for asset transfer according to article 69 ff. of the Federal Act on Merger, Demerger, Transformation and Transfer of Assets (MerA). However, not all open questions have been clarified. As long as the CISA does not contain restructuring provisions, as is the case with closed-ended collective investment schemes, generally the MerA and/or the Swiss Code of Obligations (CO) apply. The interplay of diverse, partly overlapping legislative bases leads to the emergence of unwanted gaps. Moreover, the partial revision of the CISA was not completely implemented at the ordinance level. Among others, the following issues have not been conclusively or clearly regulated: the permitted combinations of mergers, the merger procedure of the SICAV, the permitted restructurings, the transformation procedure as well as the application scope of the asset transfer for collective investment schemes according to the relevant merger regulations. Although these questions will be clarified in the following article through a systematic and teleological analysis of the relevant regulations, it is to be hoped that the gaps will be closed within the next CISA revision in order to guarantee comprehensive legal certainty.

Keeping Promises : Implementing the UNESCO Convention on Cultural Diversity into EU's Internal Policies

Irrespective of the diverse stances taken on the UNESCO Convention’s bearing in the external relations context, since its wording is fairly open-ended, it is clear to all observers that the Convention’s impact will largely depend on how it is implemented. The discussion on the domestic implementation of the Convention, both in the political and in the academic discourses, is only just emerging. The implementation model of the EU and its Member States could set an important example for the international community and for the other State Parties that ratified the UNESCO Convention, as the EU and the Member States acting individually, played a critical role in the approval of the Convention, and in the longer process of promoting cultural concerns on the international scene. Against this background, it is the objective of the present article to analyse in how far EU’s internal policies are taking account of the spirit and letter of the UNESCO Convention on Cultural Diversity, to critically assess these policies and make some recommendations for adjustment.

Business as Usual? : An Appraisal of the Implementation of the UNESCO Convention on Cultural Diversity into EU’s Media Law and Policies

Irrespective of the diverse stances taken on the effect of the UNESCO Convention on Cultural Diversity in the external relations context, since its wording is fairly open-ended, it is clear to all observers that the Convention’s impact will largely depend on how it is implemented domestically. The discussion on the national implementation of the Convention, both in the policy and in the academic discourses, is only just emerging. The implementation model of the EU could set an important example for the international community and for the other State Parties that have ratified the UNESCO Convention, as both the EU and its Member States acting individually, have played a critical role in the adoption of the Convention, as well as in the longer process of promoting cultural concerns on the international scene. Against this backdrop, this article analyses the extent to which the EU internal law and policies, in particular in the key area of media, take into account the spirit and the letter of the UNESCO Convention on Cultural Diversity. The article seeks to critically evaluate the present state of affairs and make some recommendations for calibration of future policies.

Business as Usual? : The Implementation of the UNESCO Convention on Cultural Diversity and EU Media Law and Policies

Irrespective of the diverse stances taken on the effect of the UNESCO Convention on Cultural Diversity in the external relations context, since its wording is fairly open-ended, it is clear to all observers that the Convention’s impact will largely depend on how it is implemented domestically. The discussion on the national implementation of the Convention, both in the policy and in the academic discourses, is only just emerging, although six years the Convention’s entry into force have passed. The implementation model of the EU can set an important example for the international community and for the other State Parties that have ratified the UNESCO Convention, as both the EU and its Member States acting individually, have played a critical role in the adoption of the Convention, as well as in the longer process of promoting cultural concerns on the international scene. Against this backdrop, this article analyses the extent to which the EU internal law and policies, in particular in the key area of media, take into account the spirit and the letter of the UNESCO Convention on Cultural Diversity. Next to an assessment of the EU’s implementation of the Convention, the article also offers remarks of normative character – in the sense of what should be done to actually attain the objective of protecting and promoting cultural diversity. The article seeks to critically evaluate the present state of affairs and make some recommendations for calibration of future policies.

Influence of credibility, warnings, and source-monitoring questions on the misinformation effect.

Introduction. Erroneous answers in studies on the misinformation effect (ME) can be reduced in different ways. In some studies, ME was reduced by SM questions, warnings, or a low credibility of the source of post-event information (PEI). Results are inconsistent, however. Of course, a participant can deliberately decide to refrain from reporting a critical item only when the difference between the original event and the PEI is distinguishable in principle. We were interested in the question to what extent the influence of erroneous information on a central aspect of the original event can be reduced by different means applied singly or in combination. Method. With a 2 (credibility; high vs. low) x 2 (warning; present vs. absent) between subjects design and an additional control group that received neither misinformation nor a warning (N = 116), we examined the above-mentioned factors’ influence on the ME. Participants viewed a short video of a robbery. The critical item suggested in the PEI was that the victim was given a kick by the perpetrator (which he was actually not). The memory test consisted of a two-forced-choice recognition test followed by a SM test. Results. To our surprise, neither a main effect of erroneous PEI nor a main effect of credibility was found. The error rates for the critical item in the control group (50%) as well as in the high (65%) and low (52%) credibility condition without warning did not significantly differ. A warning about possible misleading information in the PEI significantly reduced the influence of misinformation in both credibility conditions by 32-37%. Using a SM question significantly reduced the error rate too, but only in the high credibility no warning condition. Conclusion and Future Research. Our results show that, contrary to a warning or the use of a SM question, low source credibility did not reduce the ME. The most striking finding was, however, the absence of a main effect of erroneous PEI. Due to the high error rate in the control group, we suspect that the wrong answers might have been caused either by the response format (recognition test) or by autosuggestion possibly promoted by the high schema-consistency of the critical item. First results of a post-study in which we used open-ended questions before the recognition test support the former assumption. Results of a replication of this study using open-ended questions prior to the recognition test will be available by June.