Diabetic retinopathy screening uptake after health education with or without retinal imaging within the facility in two AYUSH hospitals in Hyderabad, India: A nonrandomized pilot study.

Purpose: In India, people with diabetes (PwDM) often seek care in the government-approved alternative medicine system, AYUSH (Ayurveda, Yoga and naturopathy, Unani, Siddha and Homeopathy). The purpose of this pilot study was to assess whether health education plus retinal imaging for diabetic retinopathy (DR) within an AYUSH hospital increased the uptake of screening for DR compared with health education and referral. Methods: The study was a nonrandomized pilot conducted in two AYUSH hospitals. Both hospitals received intervention on educating the AYUSH practitioners about DR screening and distributing health education materials to diabetic patients. In one hospital in addition to education, retinal imaging by a trained technician with remote grading by an ophthalmologist was provided, while in another hospital PwDM were referred to nearby eye hospitals for screening. The uptake of screening was assessed through registers and phone calls. Results: At baseline, only 10.7% of 178 PwDM were aware of DR and only 8% had undergone DR screening. After the intervention, in the hospital where screening was provided, all (100%) eligible patients (101) underwent digital imaging, whereas in the other hospital only 25% of 77 eligible patients underwent screening in eye hospitals (P < 0.001). Conclusion: AYUSH hospitals could provide a feasible and acceptable location for providing DR screening services. Further studies are required to assess scale-up of such intervention.

Parental use of the Internet to seek health information and primary care utilisation for their child: a cross-sectional study.

BACKGROUND: Using the Internet to seek health information is becoming more common. Its consequences on health care utilisation are hardly known in the general population, in particular among children whose parents seek health information on the Internet. Our objective was to investigate the relationship between parental use of the Internet to seek health information and primary care utilisation for their child. METHODS: This cross-sectional survey has been carried out in a population of parents of pre-school children in France. The main outcome measure was the self-reported number of primary care consultations for the child, according to parental use of the Internet to seek health information, adjusted for the characteristics of the parents and their child respectively, and parental use of other health information sources. RESULTS: A total of 1,068 out of 2,197 questionnaires were returned (response rate of 49%). No association was found between parental use of the Internet to seek health information and the number of consultations within the last 12 months for their child. Variables related to the number of primary care consultations were characteristics of the child (age, medical conditions, homeopathic treatment), parental characteristics (occupation, income, stress level) and consultation of other health information sources (advice from pharmacist, relatives). CONCLUSION: We did not find any relationship between parental use of the Internet to seek health information and primary care utilisation for children. The Internet seems to be used as a supplement to health services rather than as a replacement.

Preparo dos pais para a desospitalização de crianças em uso de traqueostomia e gastrostomia / Preparación de los padres para la deshospitalización de niños en uso de traqueostomía y gastrostomía / Parents' preparation for the dehospitalization of children using tracheostomy and gastrostomy

RESUMO Objetivo: relatar a experiência de uma ação educativa para o preparo dos pais para a desospitalização de crianças em uso de traqueostomia e gastrostomia. Método: relato de experiência sobre uma ação educativa, que é parte de um Programa de Treinamento de um hospital público de alta complexidade referência em pediatria, no período de dezembro de 2017 a dezembro de 2018. Resultados: o preparo dos responsáveis para a desospitalização de crianças em uso de traqueostomia e gastrostomia foi feito a partir de 5 etapas: 1) Instruções aos pais; 2) Treinamento dos pais para manuseio do dispositivo utilizado pela criança; 3) Manipulação dos dispositivos pelos pais sob supervisão do enfermeiro; 4) Feedback oferecido pela Enfermagem; e 5) Avaliação da ação educativa. Considerações finais: Acredita-se que a educação terapêutica fornecida aos envolvidos contribuiu na qualificação do cuidado à criança em uso de traqueostomia e gastrostomia, favorecendo sua qualidade de vida e reduzindo as intercorrências domiciliares relacionadas ao manuseio inadequado dos dispositivos em questão.

resumen Objetivo: relatar la experiencia de una acción educativa para la preparación de los padres para la deshospitalización de niños en uso de traqueostomía y gastrostomía. Método: relato de experiencia sobre una acción educativa, que hace parte de un Programa de Entrenamiento de un hospital público de alta complejidad referencia en pediatría, en el período de diciembre de 2017 a diciembre de 2018. Resultados: la preparación de los responsables para la deshospitalización de niños en uso de traqueostomía y gastrostomía se hizo a partir de 5 etapas: 1) Instrucciones a los padres; 2) Entrenamiento de los padres para manejo del dispositivo utilizado por el niño; 3) Manipulación de los dispositivos por los padres bajo supervisión del enfermero; 4) Feedback ofrecido por la Enfermería; y 5) Evaluación de la acción educativa. Consideraciones finales: Se cree que la educación terapéutica proporcionada a los involucrados contribuyó en la calificación del cuidado del niño en uso de traqueostomía y gastrostomía, favoreciendo su calidad de vida y reduciendo las complicaciones domiciliarias relacionadas con el manejo inadecuado de los dispositivos en cuestión.

ABSTRACT Objective: to report the experience of an educational action for the preparation of parents for the dehospitalization of children using tracheostomy and gastrostomy. Method: experience report on an educational action, which is part of a Training Program of a public hospital of high complexity reference in pediatrics, from December 2017 to December 2018. Results: the preparation of those responsible for the dehospitalization of children using tracheostomy and gastrostomy was made from 5 stages: 1) Instructions to parents; 2) Training of parents to handle the device used by the child; 3) Manipulation of the devices by parents under the supervision of the nurse; 4) Feedback offered by Nursing; and 5) Evaluation of educational action. Final considerations: It is believed that the therapeutic education provided to those involved contributed to the qualification of care for children using tracheostomy and gastrostomy, favoring their quality of life and reducing home complications related to inadequate handling of the devices in question.

Prostate Cancer Screening Perception, Beliefs, and Practices Among Men in Bamenda, Cameroon.

Prostate Cancer (CaP) is the most commonly diagnosed cancer among Cameroonian men. Due to inadequate infrastructure, record keeping, and resources, little is known about its true burden on the population. There are rural/urban disparities with regards to awareness, screening, treatment, and survivorship. Furthermore, use of traditional medicine and homeopathic remedies is widespread, and some men delay seeking conventional medical treatment until advanced stages of CaP. This study examined the perceptions, beliefs, and practices of men in Cameroon regarding late stage CaP diagnoses; identified factors that influence screening decision; and ascertained how men decided between traditional or conventional medicine for CaP diagnosis and treatment. Semistructured focus groups were used to collect data from men in Bamenda, Cameroon. Qualitative data analysis was used to analyze transcripts for emerging themes and constructs using a socio-ecological framework. Twenty-five men participated in the study, with an average age of 59. Most of the participants had never received a prostate screening recommendation. Socioeconomic status, local beliefs, knowledge levels, awareness of CaP and screening methods, and stigma were prominent themes. A significant number of Cameroonian men receive late stage CaP diagnosis due to lack of awareness, attitudes, cultural beliefs, self-medication, and economic limitation. To effectively address these contributing factors to late stage CaP diagnosis, a contextually based health education program is warranted and should be tailored to fill knowledge gaps about the disease, dispel misconceptions, and focus on reducing barriers to utilization of health services.

Complementary medicine for alcohol dependence in Italian services: a mail questionnaire.

It is well known that Complementary Medicine (CM) is extensively used in western countries for the treatment of many afflictions. CM has been recently promoted in addiction treatment. To evaluate CM use in alcohol dependence we planned a mail questionnaire for Italian alcohol services. We sent out 612 questionnaires. Health services that were unable to respond to the questionnaire within a 20-day limit period were contacted by phone and if we obtained agreement to participate in the study the questionnaire was sent by fax. We obtained 312 (51.82%) completed questionnaires. Only 16.50% of Italian services use CM for alcohol dependence treatment and acupuncture is utilized more frequently than other methods (phytotherapy, homeopathy, etc.). In Italian alcohol services CM is identified as an instrument incorporated into traditional alcohol treatments (self-help groups, drug treatment, etc.) and not an alternative method. In fact, health services that use it as a principal method of treatment were a rare event in our study (1%). CM plays an integrated role with traditional forms of alcohol treatment in Italian alcohol services and this utilization could be useful to reduce drop-outs and improve alcohol treatment compliance.

Percepções sobre homeopatia na perspectiva de discentes dos cursos de saúde de um centro universitário de Recife-PE / Healthcare students perceptions about homeopathy at a university of Recife-PE

A homeopatia é um método terapêutico que tem como princípio "semelhante cura semelhante", tendo como base a experimentação das preparações altamente diluídas e sucussionadas, com objetivo de produzir em pessoas sadias sintomas semelhantes aos da doença que devem combater. O interesse da população por ela vem aumentando e há necessidade de formar profissionais qualificados no ensino de práticas integrativas e complementares para que avancem no SUS. Diante disso, o objetivo deste estudo foi descrever as percepções sobre homeopatia na perspectiva de discentes dos cursos de saúde de um centro universitário privado em Recife-PE. Para tanto, foi realizado um estudo transversal, descritivo e quantitativo a partir da aplicação de questionário a 500 estudantes de cursos de saúde, entre outubro e novembro de 2018. Apesar de 65,2% dos discentes relatarem ter ouvido falar sobre homeopatia, 73% declararam ter pouco ou nenhum conhecimento sobre as formas de tratamento. Além disso, 82,8% dos discentes afirmaram não conhecer as PNPIC (Política Nacional de Práticas Integrativas e Complementares no SUS), e nem saber que medicamentos homeopáticos são distribuídos gratuitamente pelo SUS (86%). Existe interesse dos estudantes de saúde em incluir homeopatia como disciplina na grade de seus cursos, afim de estarem aptos para oferecer um atendimento integral aos pacientes. Portanto, há necessidade de instituições de ensino superior investirem e promoverem disciplinas que abordem a homeopatia, para formarem profissionais com maior conhecimento sobre as PIC, o que irá acarretar maior informação para a população, contribuindo na melhoria da saúde individual e coletiva através da saúde pública.

Homeopathy is a type of therapy method that follows the principle of "like cures like", based on the experimentation of high diluted preparations, with the aim of of producing in a healthy person, symptoms most 'like' the symptoms the person is suffering from. There has been increasing interest in these therapies and, therefore, is important to train qualified professionals focused on homeopathy and complementary and alternative medicine for work in the SUS. The aim of this study was to describe the perceptions about homeopathy from the perspective of healthcare students at a private university in Recife-PE. A cross-sectional, descriptive and quantitative study was conducted, between the months of October and November 2018. To assess opinions about homeopathy, 500 students were asked questions in a questionnaire. Although 65.2% of the students report having heard/read about homeopathy, 73% have little or no knowledge about this alternative therapie. In addition, 82.8% did not know the PNPIC (National Policy for Integrative and Complementary Practices in the SUS), nor that homeopathic medicines are distributed free of charge by the SUS (86%). Healthcare students are interested in including homeopathy as a discipline in their graduations, in order to be able to offer comprehensive care to patients. Therefore, there is a need for universities to invest and promote disciplines that address homeopathy, to train professionals with greater knowledge about alternative and complementary medicine, which will lead to more information for the population, contributing to the improvement of individual and collective health through public health.

Knowledge, Attitude, and Practice Related to Diabetes Mellitus Among Diabetics and Nondiabetics Visiting Homeopathic Hospitals in West Bengal, India.

High prevalence of undiagnosed cases of diabetes mellitus and poor knowledge, awareness, and practice has increased premature death, costly complications, and financial burden. A cross-sectional survey was conducted in November 2014 on 273 diabetics and 355 nondiabetics in 3 government homeopathic hospitals in West Bengal, India. A self-administered questionnaire assessing knowledge, awareness, and practice related to diabetes was used. A total of 17.5% to 29.3% of the participants were aware of the normal blood sugar level. Lack of insulin, frequent urination, hypertension, and poor wound healing were identified most frequently as the cause, symptom, association, and complications. A total of 35.5% to 46.5% said that diabetes was preventable; 14.1% to 31.9% knew that diabetes was controllable rather than curable. Consumption of planned diet, avoiding sugar, and testing blood sugar were the most frequently identified components of healthy lifestyle, diabetic diet, and diagnostic domain. Diabetics had higher knowledge and awareness than nondiabetics (P < .0001); still the latter need to be made aware and knowledgeable to curtail the ever-increasing burden of diabetes.

Public awareness of warning symptoms, risk factors, and treatment of stroke in northwest India.

BACKGROUND AND PURPOSE: This study assessed public awareness of warning symptoms, risk factors, and treatment of stroke in Ludhiana, Punjab, North West India. METHODS: A hospital-based survey was conducted between February 2002 and September 2002 by the Stroke section of Christian Medical College. The study subjects were relatives of patients without history of stroke, attending the outpatient department of the hospital. Trained medical students, interns, and a nurse interviewed subjects using a structured, pretested, open-ended questionnaire. RESULTS: Nine hundred forty-two individuals were interviewed during the study period (56.4% men, mean age 40.1 years, age range 15 to 80 years). Forty-five percent of the subjects did not recognize the brain as the affected organ in stroke. In the multivariate analysis, higher education (P<0.001; odds ratio 2.6; 95%, CI 1.8 to 3.8) and upper socioeconomic status (P<0.005; odds ratio 1.6; CI, 1.1 to 2.2) correlated with a better knowledge of which organ was affected in stroke. Twenty-three percent of the participants did not know a single warning symptom of stroke. Twenty-one percent of the subjects could not identify even a single risk factor for stroke. Seven percent of the study population believed that oil massage would improve stroke victims. A small proportion of subjects believed in witchcraft, faith healing, homeopathic, and ayurvedic treatment (3%). CONCLUSIONS: This hospital-based survey reveals a better awareness of stroke warning signs and risk factors. However, knowledge regarding the organ involved, etiology, and treatment of stroke is lacking. Considerable education is needed to increase public awareness in modern concepts of stroke treatment.

Utility of nutraceutical products marketed for cognitive and memory enhancement.

This article identifies a convenience sample of 14 memory-enhancing herbal products that were found to be available commercially, examines their active ingredients, states their claims, and evaluates the available evidence to determine their efficacy. The analyses identified four problematic areas. First, a majority of the products use cognitive terminology, which leads consumers to anticipate an intended cognitive benefit. Second, some ingredients are completely homeopathic and contain components not known outside of the homeopathic field. Third, the evidence of treatment efficacy is often contradictory, because products are recommended for purposes other than cognitive or memory loss. Finally, the manufacturers of the product have usually conducted the research on individual products. Until more research is available, it is suggested that holistic nursing professionals exercise caution in recommending nutraceuticals to their patients/clients for the use of cognitive improvement or memory enhancement.

Health education or a shared therapeutic project? Health care goes beyond the pedagogical dimension.

The general objective of this research was to assess the possible contribution of homeopathy to the development of caregiving therapeutic projects in multidisciplinary workshops of permanent education in health, in the context of primary health care. The chosen points of analysis were the series of inconveniences expressed by health workers with respect to their work processes and it was the emergence of the theme of health education in the first meetings with the teams that led to the production of this article. This study discusses the existential territory of "being a health professional" as understood from a concept of education as a significant benchmark, and of a certain interventionist mission as a transcendent value. A progressive waning of the importance of health education was observed during the workshops, sometimes even disappearing from the discussions, as the caregiving therapeutic projects took shape. The conclusion reached is that this waning involved a process of moving towards a pact with the health system user, eventually considered to be a valid interlocutor; and that health care transcends any strictly pedagogical dimension.

Psychosocial antecedents of injection risk reduction: a multivariate analysis.

The AIDS risk reduction model (ARRM) predicts decreased occurrence of AIDS risk behavior through a three-stage process: (a) perceiving one's behavior as risky and recognizing one's skills to reduce the behavior, (b) forming an intention to change behavior, and (c) acting on that intention. We used the ARRM to test a stage-based longitudinal structural equation model of the impact of intention to reduce injection risk behavior on subsequent behavior change in a sample of 294 HIV-negative opiate-addicted individuals in treatment. Intended risk reduction and continuous participation in treatment significantly predicted less injection risk behavior. Greater self-efficacy, less baseline risk behavior, less perceived susceptibility to AIDS, and greater fear of AIDS predicted intention to reduce risk. Leverage points for change are discussed.

The House of Lords report on complementary medicine: a summary.

The House of Lords Science and Technology Committee reviewed a large amount of oral and written evidence from a wide variety of sources in order to scrutinize CAM. In their published report, they propose that CAM be subdivided into three groups for operational purposes. They note that public satisfaction with CAM is high and use of CAM is increasing. Evidence is required that CAM has an effect above and beyond placebo, and once this is provided the public should have access to it and its potential benefits. Public interest is not protected by the current lack of regulation of CAM, which should be organized in an appropriate way by and for each therapy. Acupuncture and herbal medicine should be subject to statutory regulation, and possibly non-medical homeopathy. The regulatory status of herbal medicines is particularly unsatisfactory, and should be clarified and enforced in law. Training for CAM professionals should be standardized and independently accredited and, for many, should include basic biomedical science. Registered conventional health professionals should become more familiar with CAM. Research into CAM requires the same rigour as is required of conventional medicine, and recommendations are made as to how research could be encouraged, including pump-priming by the National Health Service and Medical Research Council. The provision of information to the public and health professionals is inadequate and recommendations are made on how this should be improved. Those working in the best regulated CAM professions should work towards integration with conventional medicine.

Effects of a health care provider intervention in reduction of sexual risk and related outcomes in economically marginal communities in Mumbai, India.

BACKGROUND: The present study assessed the effectiveness of a brief narrative intervention implemented by trained biomedical and Ayurveda, Yoga, Unani, Siddha, Homeopathy (AYUSH) providers from three low-income communities in Mumbai, India. METHODS: A quasi-experimental research design compared attitudinal and behavioural changes among a cohort of 554 patients presenting gupt rog ('secret sexual illnesses') to biomedical and AYUSH providers who were trained in the narrative intervention model (NIM; referred to as 'narrative prevention counseling' in the intervention manual) with those providing standard care (untrained in NIM). Data were analysed using multivariate and longitudinal statistical models. RESULTS: Patients who received treatment for gupt rog from trained providers reported receiving a significantly higher number of services than those receiving services from untrained providers (mean 8.9 vs 7.6 services, respectively; P<0.001). In addition, a higher number of patients seeing the trained providers no longer had gupt rog problems than those seeing untrained providers (42% vs 25%, respectively; P<0.001). Patient-reported sex with a partner who was not the wife decreased significantly from baseline to follow-up for the entire sample but was significantly greater among patients receiving treatment from trained AYUSH providers (from 27% at baseline to 2% at follow up) compared with untrained providers (from 18% at baseline to 5% at follow up; P<0.001). CONCLUSIONS: The results support the effectiveness of brief narrative intervention in primary care settings for reducing sexual risk and associated vulnerabilities among married men.

Orrin hatch and the dietary supplement health and education act: Pandora's Box revisited.

Products of unknown safety and efficacy were once referred to as "quackery," and the US Food and Drug Administration (FDA) was empowered to protect public health by preventing their sale and forcing them from the market. However, in 1994, the Dietary Supplement Health and Education Act legitimized their sale as "dietary supplements." Sales increased dramatically, and many Americans now use herbals, homeopathics, and other so-called supplements. The Food and Drug Administration cannot act against them until patients have already been harmed, a dangerous situation. Furthermore, no governmental agency has the authority to force the manufacturers to furnish proof of efficacy. It is vital for physicians to warn their patients that they should use these unproven products only with great caution, and must never discontinue legitimate medical therapy in lieu of unproven products.

Ficha de avaliação clínica de membros inferiores para prevenção do pé diabético / Ficha de avaliação clínica de membros inferiores para prevención do pé diabético / Clinical evaluation form of lower members for diabetic foot prevention

Objetivo: Elaborar ficha de avaliação clínica (FAC) dos membros inferiores (MIs) para prevenção do pé diabético (PD). Métodos: Partindo de revisão da literatura, elaborou-se uma FAC com 4 fases: as fases 1 e 2 contemplam o exame clínico (anamnese e exame físico, respectivamente) com ênfase na avaliação dos pés e na pesquisa de fatores de risco para úlceras; a fase 3 avalia o autocuidado com os pés e a fase 4 descreve as principais orientações para este cuidado. Resultados: Após a realização das fases 1 e 2, segue uma classificação de risco de ulceração dos pés. A fase 3 avalia com dez questões os cuidados com os pés e a fase 4 apresenta dez orientações educacionais para prevenção do PD. Conclusão: A FAC proposta possibilita detectar e intervir precocemente no risco de ulceração nos pés.

Objective: To elaborate a clinical evaluation sheet (CES) of the lower limbs (LL) for diabetic foot (DF) prevention. Methods: Based on literature review, a four-phased CES has been elaborated: phases 1 and 2 contemplate clinical evaluation (anamnesis and physical evaluation, respectively) with emphasis on feet evaluation and search for soreness risk factors; phase 3 evaluates feet care and phase 4 describes the main guidelines for this care. Results: With the completion of phases 1 and 2, a feet soreness risk rating follows. Phase 3 evaluates feet care with ten questions and phase 4 presents ten educational guidelines for DF prevention. Conclusion: The proposed CES enables the detection and early intervention on foot soreness risk.

Objetivo: Desarrollar formulario de evaluación clínica (FEC) de los miembros inferiores (MIs) para la prevención del pie diabético (PD). Métodos: A partir de la revisión de la literatura, fue preparada una FEC con 4 fases: fases 1 y 2 incluyen examen clínico (anamnesis y la exploración física, respectivamente), con énfasis en la evaluación de los pies y los factores de riesgo para buscar úlceras; fase 3 se evalúa el auto-cuidado con sus pies y la fase 4 se describen las pautas principales para este tipo de atención. Resultados: Después de la terminación de las fases 1 y 2 sigue la clasificación de riesgo de la ulceración de los pies. Fase 3 evalúa con diez preguntas del cuidado de los pies y la fase 4 presenta diez directrices educativas para prevenir el PD. Conclusión: La propuesta FEC permite detectar e intervenir temprano en riesgo de ulceración de los pies.

A homeopatia como a arte de cuidar em saúde: análise da percepção dos usuários do SUS sobre o trabalho de homeopatia na cidade de Macaé/RJ / Homeopathy as healthcare art: analysis of public health service users’ perception of homeopathy in Macaé, Rio de Janeiro, Brazil

Através da iniciativa da Secretaria Municipal de Saúde, a cidade de Macaé vem utilizando um protocolo de intervenção homeopática para prevenção e tratamento da dengue desde 2007, atualizado anualmente, incluído no plano municipal de contingência da dengue, com resultados positivos, diminuindo a intensidade dos sintomas e o período de duração da enfermidade, proporcionando uma melhoria mais rápida do paciente. Nesse contexto, o objetivo do presente estudo foi investigar a percepção dos usuários quanto ao trabalho de Homeopatia contra a Dengue, realizado no município de Macaé-RJ para subsidiar a elaboração de um folder a ser utilizado como meio de divulgação científica. (AU)

Based on an initiative of the Municipal Health Secretary, a protocol for homeopathic intervention targeting prophylaxis and treatment of dengue has been applied in Macaé, Rio de Janeiro, since 2007. Inclusion of homeopathy in the municipal program against dengue had positive results, with reduction of the intensity of symptoms and of the duration of disease. Within this context, the aim of the present study was to investigate the perception of public health service users of program Homeopathy against Dengue in Macaé as grounds for the elaboration of educational materials. (AU)

A homeopatia como a arte de cuidar em saúde: análise da percepção dos usuários do SUS sobre o trabalho de homeopatia na cidade de Macaé/RJ / Homeopathy as healthcare art: analysis of public health service users’ perception of homeopathy in Macaé, Rio de Janeiro, Brazil

Através da iniciativa da Secretaria Municipal de Saúde, a cidade de Macaé vem utilizando um protocolo de intervenção homeopática para prevenção e tratamento da dengue desde 2007, atualizado anualmente, incluído no plano municipal de contingência da dengue, com resultados positivos, diminuindo a intensidade dos sintomas e o período de duração da enfermidade, proporcionando uma melhoria mais rápida do paciente. Nesse contexto, o objetivo do presente estudo foi investigar a percepção dos usuários quanto ao trabalho de Homeopatia contra a Dengue, realizado no município de Macaé-RJ para subsidiar a elaboração de um folder a ser utilizado como meio de divulgação científica...

Based on an initiative of the Municipal Health Secretary, a protocol for homeopathic intervention targeting prophylaxis and treatment of dengue has been applied in Macaé, Rio de Janeiro, since 2007. Inclusion of homeopathy in the municipal program against dengue had positive results, with reduction of the intensity of symptoms and of the duration of disease. Within this context, the aim of the present study was to investigate the perception of public health service users of program Homeopathy against Dengue in Macaé as grounds for the elaboration of educational materials...

Influence of patient's perceptions, beliefs and knowledge about cancer on treatment decision making in Pakistan.

INTRODUCTION: Cancer is a cause of major disease burden across the world and Pakistani data suggest that its incidence is increasing. Pakistan's socio-cultural history, social practices, religious beliefs and family systems differ in many ways from rest of the world. These factors make the practice of oncology a challenge. MATERIALS AND METHODS: A comprehensive questionnaire focusing on socio-cultural and religious aspects was administered to patients with a diagnosis of cancer and receiving chemotherapy at the Aga Khan University Hospital, Karachi, Pakistan. RESULTS: A total of 230 patients agreed to answer the questionnaire, with a mean age of 46 years and 63% were females. Obtaining some formal education was claimed by 87%, 75.2% had received some treatment before seeing an oncologist, including homeopathic physicians and faith healers. Of all 27 % thought that cancer is contagious, a fact observed more so in those who were illiterate, 27 % believed in some myth such as past sins, evil eye or God's curse as to be cause of their cancer, while 39.6% thought that cancer can be prevented by a regular religious activity. Some 30% thought that a meaningful life after diagnosis of cancer was not possible and 28%considered that they did not have proper information about chemotherapy. About 73% wanted to have their treatment related decision made by the treating physician. CONCLUSIONS: Patient related beliefs in myths and concerns are unique in the socio-cultural set up of Pakistan. If physicians are better aware of these factors, they may be able to handle patient related issues in a more effective way.

Substance abuse among Iranian high school students.

PURPOSE OF REVIEW: In this study, we reviewed data on drug use among high school students in Iran. RECENT FINDINGS: Published epidemiological studies in international and domestic journals show that drug use/abuse is a serious mental health problem in Iran. There is cultural support for opium in Iran and also there is cultural tolerance for tobacco smoking, especially as water pipe smoking in Iranian families. Alcohol, opium and cannabis are the most frequently used illicit drugs, but there are new emerging problems with anabolic steroids, ecstasy and stimulant substances, such as crystal methamphetamine. SUMMARY: There is a serious drug abuse problem among Iranian high school students. It could be due to role modeling by parents - mainly fathers - and also cultural tolerance of some substances. Early onset of tobacco smoking, with a daily use rate between 4.4 and 12.8% in high school students, is an important risk factor for other drug abuse problems. Use of all types of drugs, except prescription drugs, is more prevalent among boys. Alcohol is the most frequently abused substance, with a lifetime rate of at least 9.9%. Lifetime rates of opiate use - mostly opium - was between 1.2 and 8.6% in different parts of the country. As drug abuse is a frequent problem among Iranian high school students, it is necessary to design and implement drug prevention programs to protect them. Such programs, including life skills training and drug education, have been operating in recent years for Iranian students from kindergarten to the university level.