Médecine et culture
In: Revue juridique et politique: indépendance et coopération ; organe de l'Institut de Droit ; organe de l'Institut International de Droit d'Expression Français, Band 37, Heft 3, S. 603-616
ISSN: 0035-3574
In: Revue juridique et politique: indépendance et coopération ; organe de l'Institut de Droit ; organe de l'Institut International de Droit d'Expression Français, Band 37, Heft 3, S. 603-616
ISSN: 0035-3574
"A doctor of the highest caliber treats an illness before it happens," a seemingly antiquated doctrine in traditional Chinese medicine, is enjoying surging popularity among practitioners in urban China and the United States today. In this essay, I examine how the meanings and contours of traditional Chinese medicine have shifted in recent decades as it is molded into a "preventive medicine" through translocal encounters. From the 1960s and the early 1970s, the emphasis China's socialist health care placed on preventive health among the rural poor shaped the practice of Chinese herbal medicine and especially acupuncture. This version of preventive medicine was also exported to the Third World, which China strove to champion. Since the end of the Cold War and especially during the 1990s, as China strives to "get on track with the world" (specifically, affluent nation-states, especially in North America and the European Union), traditional Chinese medicine has been rapidly commodified and reinvented as a new kind of preventive medicine tailored for cosmopolitan, middle-class lifestyles. The emergence of this radically new preventive medicine resuscitates certain stories of antiquity and continuity, emphasizing that traditional Chinese medicine has always been "preventive" while obliterating recent memories of the proletariat world and its preventive medicine.
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In: https://hdl.handle.net/11427/31696
Natural resource governance in Africa is characterised by increased commercialisation of natural resources, the promotion of community-based natural resource management, and a re-appropriation of traditional authorities and customary law as evidenced by their inclusion in statutory frameworks. Yet, knowledge of the interaction and effect of these multiple governance arrangements on local communities is limited. Using the lens of devil's claw (Harpagophytum spp.), a commercial non-timber forest product, this research examines the interface between statutory, traditional and comanagement governance systems; the broader historical and political-economic contexts that shape governance systems; livelihood and sustainability outcomes at the local level; and the role of power in determining environmental, social and economic outcomes. The research adopted a case study method with three study sites selected in the Zambezi Region, Namibia – Balyerwa Conservancy, Lubuta Community Forest and Sachinga. All rural communal areas, selection was based on their distinct governance arrangements, including a range of traditional and co-management institutions, development interventions and statutory regulation. Qualitative methods were used and included questionnaires, focus group discussions, interviews, participant observation and documentary evidence. An institutional mode of analysis and a political ecology approach were applied. Theoretical perspectives to inform the research were drawn from discourses on governance, institutions, political ecology, power and access. The novelty in using a political ecology approach to develop adaptive governance theory was to move beyond understandings of the conscious mechanisms of institutions embodied in their structure, to a more nuanced understanding of socially-embedded institutions and the unconscious mechanisms that also determine social and environmental outcomes. The empirical knowledge gained from this research shows that both structural and socially-embedded institutional constraints are hindering the objectives of non-timber forest product governance. The results of this research affirm that governance is hybridising and that dichotomised descriptions of governance as customary or statutory, self-organising or hierarchical, do not capture the complexity of these evolving fusions of governance at the local level. Where a multiplicity of institutions existed at the local level, the role of the State was diminished and where co-management was in place, communities benefited from non-governmental organisation support which enabled greater benefits for harvesters and more sustainable practices. However, power was not restructured under such arrangements and differentials in access, knowledge, decision-making and benefits remained. Where co-management was not in place, harvesters were not supported in their harvesting activities and were most vulnerable to exploitation by traditional leaders and buyers. This exacerbated competition over the resource and unsustainable harvesting was more prevalent. Devil's claw was used as a traditional medicine by some members of these communities but did not hold significant socio-cultural value. Customary systems of management for devil's claw were therefore weak or absent and oversight of the resource was perceived to be the jurisdiction of the State. Statutory regulation of devil's claw was however found to be ineffective; when in place, the State perceived the co-management institutions to be responsible for monitoring and evaluation. The implementation of quotas, traceability and better pricing from exporters exerted a greater influence than regulation in promoting sustainability. In the absence of non-governmental support and exporters adhering to quotas, unsustainable harvesting prevailed. A central finding is that alteration, the bending or breaking of rules by local communities, is a strategy to cope with economic precariousness that is inflicted by broader political-economic conditions. This affirms the need for an alternative economic logic to be examined that incorporates non-timber forest products into diverse agroforestry production systems that stimulate markets within rather than external to localities and draws on existing cultural practices and preferences to shape landscapes and economies in more holistic, equitable ways. The research concludes that benefits for harvesters and the sustainability of devil's claw are currently hindered by institutional complexity, overlapping mandates, insufficient value of the resource at the local level and a failure to instil harvester autonomy. To address these structural and sociallyembedded institutional constraints severalrecommendations are made. First, to shift co-management from decentralisation to bottom-up democratisation by devolving authority, not just responsibility, to the resource users themselves. By enabling the freedom to experiment, socially-embedded institutional constraints such as dominant narratives of 'traditional' and 'uneducated' that perpetuate unproductivity and disincentivise learning can be reframed. Second, to remove unnecessary and inefficient bureaucratic layers through re-evaluating the social scale at which natural resource management would work best and scale-up in responsibility as required to match ecological and functional scale. This would diffuse the decision-making power of the traditional authorities and the ineffectiveness of the State in communal areas whilst maintaining a role for these institutions. Lastly, to enhance market transparency to promote the mutually beneficial and regulating role between harvesters and exporters, and to emphasise the commercialisation of non-timber forest products with socio-cultural value, robust customary systems of management and local markets. The objective is not to eliminate statutory governance in favour of customary governance, nor to denounce traditional authorities in favour of co-management institutions, but to democratise power in brokering new invited spaces of modern rural governance. This study contributes to governance theory by conceptualising a framework that addresses the structural and socially-embedded institutional constraints hindering adaptive governance of NTFPs and which offers an operational solution to balance power in a bottom-up process of democratisation where legal pluralism is prevalent.
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Cover -- Table of Contents -- Communicable Disease -- Community Health -- Correctional Health Care -- Drug Abuse -- Epidemiology -- Health and Medicine -- Health and Society -- Industrial Health and Medicine -- Public Health -- Public Health Management -- Rural Health -- Urban Health -- World Health Organization -- Index.
Article Development directions of country tourism in Klaipeda region analyzes the situation of rural tourism homesteads in Klaipeda region, development opportunities, directions and synergies along with other tourism segments such as health tourism. The synergistic process of networking and one of the main forms of the cluster perspective are analyzed. The following are also proposed directions for the development of the region: the development of health services in rural areas: certification of the region's culinary heritage; promotion of cultural heritage, lifestyle features, traditions, crafts, customs; folk medicine and health services (treating using medicinal plants, bee products or traditional water treatments); the development of maritime tourism and the formation of regional politics.
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Article Development directions of country tourism in Klaipeda region analyzes the situation of rural tourism homesteads in Klaipeda region, development opportunities, directions and synergies along with other tourism segments such as health tourism. The synergistic process of networking and one of the main forms of the cluster perspective are analyzed. The following are also proposed directions for the development of the region: the development of health services in rural areas: certification of the region's culinary heritage; promotion of cultural heritage, lifestyle features, traditions, crafts, customs; folk medicine and health services (treating using medicinal plants, bee products or traditional water treatments); the development of maritime tourism and the formation of regional politics.
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In: http://hdl.handle.net/11427/3406
Bibliographical references. ; With the advent of the new government and the end of the apartheid era, the Department of Welfare investigated methods whereby the demand for equitable access to state subsidised homes for the aged might be met. It was decided to develop an instrument to assess dependency needs of older persons that might warrant admission to homes for the aged. Financial constraints dictated that only 2% of those over the age of 65 years could be institutionalised in state subsidised homes. An instrument with high specificity and sensitivity and good face and construct validity was required in order not to exclude the needy or include the undeserving in subsidised institutional care. The instrument formerly used in South Africa was designed to assess dependency needs of urban-living individuals and assumed relative affluence in contrast to the reality of the situation of the bulk of the South African population. The instrument was deficient in that it assessed only mental and physical disabilities. It did not take into account the wide disparities relating to primary needs (such as water, food, sanitation and security) that exist among communities with widely disparate socio-economic status. Since South Africa is a developing country, a significant component of the elderly population live in extreme poverty, often in rural subsistence-economy conditions. Instruments used in other countries, which assume a certain level affluence, are thus not applicable to the majority of the South African population.
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Background: The MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services. Objectives: This study analyses the effect of the intervention on the utilization of maternal and newborn services and care practices. Methods: The quasi-experimental pre- and post-comparison design had two main components: community mobilization and empowerment, and health provider capacity building. The primary outcomes were utilization of antenatal care (ANC), delivery and postnatal care, and newborn care practices. Baseline (n = 2237) and endline (n = 1946) data were collected from women of reproductive age. The data was analysed using difference in differences (DiD) analysis and logistic regression. Results: The DiD results revealed an 8% difference in early ANC attendance (p < 0.01) and facility delivery (p < 0.01). Facility delivery increased from 66% to 73% in the intervention area, but remained unchanged in the comparison area (64% vs 63%, p < 0.01). The DiD results also demonstrated a 20% difference in clean cord care (p < 0.001) and an 8% difference in delayed bathing (p < 0.001). The intervention elements that predicted facility delivery were attending ANC four times [adjusted odds ratio (aOR) 1.42, 95% confidence interval (CI) 1.171.74] and saving for maternal health (aOR 2.11, 95% CI 1.39-3.21). Facility delivery and village health team (VHT) home visits were key predictors for clean cord care and skin-to-skin care. Conclusions: The multisectoral approach had positive effects on early ANC attendance, facility deliveries and newborn care practices. Community resources such as VHTs and savings are crucial to maternal and newborn outcomes and should be supported. VHT-led health education should incorporate practical measures that enable families to save and access transport services to enhance adequate preparation for birth. ; Supplement: 4 Special Issue: MANIFEST (Maternal and Neonatal Implementation for Equitable Systems Study)
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BACKGROUND: Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan's health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan. METHODS: An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental factors. Qualitative research methods comprising of semi-structured interviews with doctors working in basic health units (BHUs) and in-depth interviews with district and provincial government health managers were used. Document review of postings, rules of business and policy actions was also conducted. Triangulation of findings was carried out to arrive at the final synthesis. RESULTS: Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies and medical facilities contributed to lack of motivation among both male and female doctors. The physicians accepted government jobs in BHUs with a belief that these jobs were more secure, with convenient working hours. Male physicians seemed to be more motivated because they faced less challenges than their female counterparts in BHUs especially during relocations. Overall, the organizational factors emerged as the most significant whereby human resource policy, career growth structure, performance appraisal and monetary benefits played an important role. Gender and marital status of female doctors was regarded as most important individual factor affecting retention and motivation of female doctors in BHUs. CONCLUSION: Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies, and medical facilities contributed to lack of motivation in physicians in our study. Our study advocates that by addressing the retention and motivation challenges, service delivery can be made more responsive to the patients and communities in Pakistan and other similar settings.
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Johnson County Hospital was a hospital located in Mountain City, TN that existed from 1972 until its final closure in 1998. The hospital faced multiple financial challenges during its existence and was forced to close three times. In 1988 it closed for the penultimate time, and as it had in the past, it counted on the community, local business and local government to reopen the hospital. Three local businessmen were particularly dedicated to reopening the county hospital and reached out to East Tennessee State University (ETSU) and their newly formed College of Medicine. A partnership was formed between the community and ETSU to open a rural campus to educate medical, nursing, public health and allied health students. This rural campus was made a reality through the Kellogg Grant awarded to ETSU in 1991 and was expanded to include graduate medical education in 1996. This collaboration between the community, local businesses, local government and ETSU was able to reopen the hospital in 1992 and jump-started interprofessional education at ETSU which is continued today in the form of the Academic Health Sciences Center and the Interprofessional Education Program.
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Nma Bida Alhaji,1 Paul Idoko Ankeli,2 Livinus Terhemba Ikpa,2 Olutayo Olajide Babalobi3 1Public Health and Epidemiology Department, Ministry of Livestock and Fisheries, Minna, Nigeria; 2Mycoplasma Laboratory, Bacterial Research Division, National Veterinary Research Institute, Vom, Nigeria; 3Department of Veterinary Public Health and Preventive Medicine, University of Ibadan, Ibadan, NigeriaCorrespondence: Nma Bida AlhajiMinistry of Livestock and Fisheries, AbdulKareem Lafene Secretariat Complex, Department of Public Health and Epidemiology, Minna PMB 175, NigeriaEmail nmabida62@gmail.comAbstract: Contagious bovine pleuropneumonia (CBPP) is an infectious and contagious respiratory disease of cattle, caused by Mycoplasma mycoides subsp. mycoides (Mmm). In this review, basic epidemiological features of CBPP, complicated by existing different strains of Mycoplasmas with similar biochemical characteristics, with preference to Sub-Saharan Africa are discussed. Many sub-Saharan African countries are challenged by variable gaps that include diagnostic tools and control strategies. Science-based issues on diagnostic procedures, vaccination, treatment, and other control strategies are discussed. Participatory epidemiology (PE), a diagnostic technique used in the identification and solving of animal health problems in rural communities, was also discussed. PE application, in conjunction with conventional diagnostic tools, will improve CBPP identification in pastoral rural communities and promote control of the disease in Africa. Furthermore, adequate CBPP control can be achieved through stronger political commitments from governments by prioritizing the disease among major diseases of high economic importance to the livestock industry for surveillance and control. Investment in CBPP control in endemic African countries will assure food security, livelihoods and the general well-being of people, and international trade.Keywords: contagious bovine pleuropneumonia, Mycoplasma mycoides subsp. mycoides, economic impact, diagnostic tools, control strategies, sub-Saharan Africa
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In: Revista de Pesquisa: Cuidado é Fundamental Online, Band 7, Heft 3, S. 2998-3008
Objective: Recognizing the explanatory models of the professional sector in relation to medicinal plants.
Method: The study was conducted with nine professionals between May and July 2011 in the rural area of
Pelotas/RS, with self-application of semi-structured questionnaires, participant observation and focus
group. All ethical guidelines for research involving human beings were respected and each professional has
been identified by the name of a medicinal plant. Results: According to the thematic analysis of data,
health professionals use medicinal plants for care of their health and are able to mention the use of plant
resources in the context of primary health care in times of self-care and palliative care. Aside from these
moments, they encourage the exclusive use of allopathic resources. Conclusion: The strength of the
professional sector with regard to medicinal plants may reflect the biomedical training, consisting of a
critical node of semantic networks.
In: Etudes rurales: anthropologie, économie, géographie, histoire, sociologie ; ER, Band 87, Heft 1, S. 175-187
ISSN: 1777-537X
«Seasons» for Selling, «Seasons» for Eating . Present-Day Accounts of Old-Time Gathering in the Margeride
Gathering, at first sight a marginal agricultural activity, presents us with a double paradox in the Margeride : on the one hand its upsurge is a recent phenomenon and is due mainly to the quest for a supplementary and, where many farms are concerned, indispensable source of income ; an on the other hand the traditions contemporary gathering is rooted in were already strongly marked by mercantile preoccupations. Hence we are witnessing the evolution of a practice from 1920 to 1950 and from 1950 to 1980 rather than a change of customs. On the basis of a comparison between the memories of the inhabitants and the objective facts, the author tries to establish the economic dependency of the gatherers in the past and the precariousness of their living conditions, and to contradict the current idealization of the peasants' relationship to «Nature» which has sprung up in the wake of certain ecological ideas, the vogue for «natural medicines», etc.
Background: The Republic of Moldova is faced with a high prevalence of non-communicable diseases (NCDs) related to lifestyle and health behavioural factors. Within the frame of the decentralisation reform, the primary health care system has been tasked to play an important role in the provision of preventative and curative NCD health services. There is however limited evidence available on the actual coverage and quality of care provided. Our paper aims to provide an updated overview of the coverage and quality of service provision in rural and urban regions of Moldova. Methods: We designed a facility-based survey to measure aspects of coverage and quality of care of NCD services across 20 districts of the Republic of Moldova. This study presents descriptive data on the structural, procedural and clinical aspects of primary healthcare delivery at health centre and family doctor office level. Adjacent private pharmacies were also assessed for the availability of essential NCD medicine. Results: Organised under the WHO Health Systems Framework, our findings highlight that service provision and information were generally the strongest among the six health systems building blocks, with more weaknesses found in the area of the health workforce, medical products, financing, and leadership/governance. Urban facilities generally fared better across all indicators. Conclusions: The gaps in service provision identified by this study require broad health system improvements to ensure NCD related policies and strategies are embedded in primary health care service provision. This likely calls for stronger coordination and collaboration between the public and private sectors and the different levels of government working towards ensuring universal health coverage in Moldova.
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Funding Source Rural and Environmental Scientific and Analytical Services, the Scottish Government Acknowledgments We thank Dr Helen Hayes for her technical support during this project. We also thank Dr Christine Kennedy for her involvement at the beginning of this project. This study was funded by Rural and Environmental Scientific and Advisory Service of Scottish Government. ; Peer reviewed ; Postprint
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