Qualitative evaluation of the acceptability and feasibility among healthcare professionals and patients of an ART multi-cycle treatment planning and continuation intervention prototype.

STUDY QUESTION: Is it possible to design an ART Treatment Planning and Continuation Intervention (TPCI) that is considered acceptable and feasible to patients and healthcare professionals (HCPs)? SUMMARY ANSWER: HCPs and patients responded positively to the TPCI prototype and perceived it as an acceptable intervention to support patients to stay engaged with planned treatment, but some concerns were raised about the feasibility of using it in practice. WHAT IS KNOWN ALREADY: People discontinue ART due to its psychological burden. Digital tools to support people undergoing ART are available but typically focus only on practical support rather than psychological support. Research about treatment continuation and multi-cycle planning indicates that cognitive factors (expectations, intentions, efficacy beliefs) should be targets of interventions designed to help patients engage with and continue treatment to meet their personal treatment plans and goals. However, it is not known whether this form of psychological support would be acceptable for HCPs and patients or feasible to implement in practice. STUDY DESIGN, SIZE, DURATION: Qualitative cognitive interviews with HCPs and patients (May 2021). Patients were eligible if they had had a consultation to start a first/repeat stimulated IVF/ICSI cycle in the 8 weeks prior to recruitment, were aged 18 or older (upper age limit of 42 years for women) and fluent in English. Eligible HCPs were those employed by a fertility clinic who were responsible for delivering treatment planning consultations to patients. PARTICIPANTS/MATERIALS, SETTING, METHODS: HCPs and patients were asked to think aloud while being exposed to and exploring the TPCI in one-to-one online cognitive interviews. The TPCI was designed to reduce treatment discontinuation via cognitive factors namely formation and maintenance of multi-cycle ART intentions and efficiency of decision-making during treatment, and continuation of treatment after an unsuccessful cycle (when recommended). To impact cognitive factors the TPCI comprised of two components: an expectation management and reasoning checklist for HCPs to use during planning consultations (TPCI Checklist) and a multi-feature cognitive support mobile application (TPCI App) for patients to use prior to and during treatment. After participants thought aloud while being exposed to the TPCI prototype (both components) they were asked open questions concerning their perceptions of the core components and activities on eight acceptability dimensions (e.g. acceptability, demand, integration). Interviews lasted between 40 and 90 min, were recorded, transcribed verbatim and analysed using thematic analysis. MAIN RESULTS AND THE ROLE OF CHANCE: Thirteen HCPs and 13 patients participated in 25 online interviews. Thematic analysis using inductive and deductive coding generated 180 codes, grouped into 22 categories and synthesized into 9 themes. The themes showed that HCPs and patients provided positive feedback about the TPCI, perceiving it as a needed, acceptable and potentially effective way to forewarn patients of the possible need for multiple cycles, to provide patients with a sense of patient-clinic collaboration and support, and to bolster treatment intentions, all of which were perceived to contribute to reduced treatment discontinuation. HCPs perceived implementation of the TPCI Checklist to be challenging in its current length due to time pressures and clinic workload. Suggestions for enhancing the TPCI Checklist and App were provided, but none required critical changes to its core components or activities. LIMITATIONS, REASONS FOR CAUTION: All patients were women recruited from social media websites, mainly associated with patient support groups, who may be highly committed to their fertility treatment. HCPs were predominantly from private fertility clinics. WIDER IMPLICATIONS OF THE FINDINGS: The findings suggest there is demand for digital support geared towards motivational aspects of undergoing ART. The TPCI is an acceptable support tool to meet that need according to HCPs responsible for delivering planning consultations and patients undergoing fertility treatment. Future research is needed to develop the prototype and examine the feasibility of implementation of the TPCI in clinics. STUDY FUNDING/COMPETING INTEREST(S): This research was financially supported by Merck Serono Ltd, an affiliate of Merck KGaA, Darmstadt, Germany. 'Merck KGaA, Darmstadt, Germany reviewed the manuscript for medical accuracy only before journal submission. The authors are fully responsible for the content of this manuscript, and the views and opinions described in the publication reflect solely those of the authors' J.B. reports personal fees from Merck KGaA, Darmstadt, Germany, Merck AB an affiliate of Merck KGaA, Darmstadt Germany, Theramex, Organon JJC, Ferring Pharmaceuticals A/S, research grant from Merck Serono Ltd, grants from ESHRE outside the submitted work and that she is co-developer of Fertility Quality of Life (FertiQoL) and MediEmo app. S.G. reports consultancy fees from TMRW Life Sciences and Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International and Gedeon Richter. C.H. declares no conflicts of interest. TRIAL REGISTRATION NUMBER: N/A.

[Traditional Chinese medicine health care from "long term taking" drugs in Shen Nong's Classic of Materia Medica].

"Taking drugs for a long term" is a qualitative expression of medication method based on the efficacy and safety of Chinese medicine, and the study on it is conducive to the full utilization of the efficacy and rational use of drugs. There are 148 drugs that can be taken for a long time recorded in Shen Nong's Classic of Materia Medica, accounting for 41% of the total drugs. This paper analyzed three-grade classification, natural qualities, four properties and five flavors, and efficacy features of the "long-term taking" drugs(LTTD), thus exploring the herbal source of traditional Chinese medicine health care and the rationality of effect accumulation by long-term taking. It was found that there were more than 110 top-grade LTTD in Shen Nong's Classic of Materia Medica, most of which were herbs, with sweet flavor, flat property, and no toxicity. The efficacies were mainly making body feel light and agile(Qingshen) and prolonging life. Eighty-three LTTD were included in the Chinese Pharmacopoeia(2020 edition). In the modern classification, tonic LTTD accounted for the most, followed by damp-draining diuretic LTTD and exterior-releasing LTTD. Twenty LTTD were included in the "List of Medicinal and Edible Products" and 21 were in the "List of Products Used for Health-care Food", involving in various modern health care effects, such as enhancing immunity, assisting in reducing blood lipids, and anti-oxidation. Shen Nong's Classic of Materia Medica is the classic source of traditional Chinese medicine health care, and its medication thought of taking drugs for a long term to accumulate effects has guiding significance for the regulation of sub-health and chronic diseases nowadays. The efficacy and safety of LTTD have been examined in practice for a long time, and some of the drugs are edible, which is unique in the whole cycle of health-care service, especially in line with the health-care needs in the aging society under the concept of Big Health. However, some records in the book are limited by the understanding of the times, which should be scientifically studied according to the Chinese Pharmacopoeia and the related regulations and technical requirements, under the attitude of eliminating falsifications and preserving the truth and keeping the right essence, so as to achieve further improvement, innovation, and development.

Impact of the National Policy on Integrative and Complementary Practices on Brazilian Public Homeopathy Services.

BACKGROUND: Homeopathy has been experiencing a period of expansion in Brazil due to its practical relevance in the face of new global and national health demands, culminating in the launch in 2006 of the National Policy for Integrative and Complementary Practices (NPICP) by the Ministry of Health of Brazil, which standardized and regularized the position of homeopathy within the Brazilian Unified Health System (SUS). AIMS: To understand the impact of the guidelines proposed by the NPICP on homeopathy services in the SUS, specifically in the south-east region of Brazil, according to the perceptions of their managers. METHODS: This is a descriptive, exploratory research study with a qualitative approach, conducted in homeopathy services in the south-east region of Brazil, through semi-structured interviews and with data processed using content analysis. RESULTS: The data show the importance of the NPICP in regulating and offering homeopathy in the services studied. However, the NPICP's objective of promoting and fully developing integrative and complementary practices has not been achieved because it has failed to translate strategies into actions. CONCLUSION: Though important to the development of homeopathy services in any given location, policies stated in the NPICP were revealed to have limited impact on the implementation and development of new services. Without further legislation, training programs and appropriate budget allocation, new services will be unable to thrive and their users unable to benefit from a more comprehensive approach to healthcare.

Regulation of non-conventional therapies in Portugal: lessons learnt for strengthening human resources in health.

BACKGROUND: The integration of non-conventional therapies (NCT) into health policies and health services delivery is a worldwide trend and might have a role in achieving Universal Health Coverage. WHO has encouraged countries to integrate NCT into health service delivery and to increase the interest and utilization by consumers. Following two resolutions by the European Parliament and by the Council of Europe, in the late 1990s, recommending the recognition of NCT and calling for EU legislation on non-conventional forms of medicine, Portugal initiated, in 2003, its path towards regulation of NCT. We analyze this process and discuss its implications and impacts in terms of health policies, health services delivery and overall health workforce. CASE PRESENTATION: The need to regulate NCT in Portugal stemmed from a growing demand for NCT (and acceptability) among lay citizens and a positive attitude among conventional health professionals which also advocated for a regulatory framework. Political efforts undertaken since 2003 allowed for important advances in the regulation of NCT, beneficiating safe professional practices, and ensuring future academic training at the highest standards, with the defining moment of the social and legal model transition occurring in 2013, when acupuncture, chiropractic, homeopathy, naturopathy, osteopathy, phytotherapy and traditional Chinese Medicine were recognized and regulated. Nevertheless, and because the process knew important time gaps, significant deficiencies arose, mainly between regulation of the training and of the professional activities and the capacity to ensure the continuous production of NCT professionals at an acceptable rate and with minimum quality standards guaranteed. CONCLUSIONS: The regulation of NCT in Portugal was lengthy but steady and was able to bring consumers a safer practice environment and NCT professionals a legal and deontological umbrella for their training, practice, and professional development. Nevertheless, and despite the growing acceptability and normative quality assurance of NCT and its workforce, the regulation process has highlighted some fragilities in terms of accessibility and availability that need attention and urgent action to achieve universal coverage.

Promoting health economic evaluation studies in the AYUSH system of medicine: the need of the hour.

The double burden of communicable and noncommunicable diseases is a major threat to the Indian public health system. AYUSH, an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa, and Homeopathy, represents the Indian system of medicine recognized by the Government of India. Mainstreaming of AYUSH is one of the key strategies of the Indian government for tackling increasing disease burden through initiatives such as AYUSH wellness centers, telemedicine, and quality control measures for medications in the AYUSH system of medicine. Such investment of resources in health systems may require economic evaluations. However, such evaluations are lacking in the AYUSH system, except for a few in homeopathy and yoga. In the absence of evidence from economic evaluations, researchers and decision makers are guided mostly by clinical efficacy while formulating healthcare strategies. In view of the increasing use of AYUSH across the country, economic evaluations of the AYUSH system are the need of the hour to aid healthcare decision making.

Can Homeopathy, a Particularly Mild Therapeutic Approach, Survive and Grow in a World of Violence?

This short treatise addresses a philosophical question concerning the place of homeopathy in our modern world. The question raised is whether a therapeutic system as peaceful, mild, and non-violent as homeopathy can survive and grow within a society that often displays the opposite characteristics.Much of contemporary society is more interested in fast and impressive cures, even if these may also bring side effects; whereas homeopathy can offer solutions with a personalized approach that requires long hours of case study by the homeopath to find the correct personal remedy that aims to bring about positive results, which the therapy can produce in deep chronic diseases.The conclusion drawn is that homeopathy does not readily fit within a modern and violent society that prefers quick and invasive solutions to its clinical problems.

Health during the Cardenismo (1934-1940). / La salud durante el Cardenismo (1934-1940).

The present symposium, Health during the Cardenismo (1934-1940), consist of four studies: Medical sanitary aspects in Mexico by Martha Eugenia Rodríguez; Campaigns against diseases by Carlos Viesca Treviño; Hospitals during Cardenism by Guillermo Fajardo Ortiz; and Military medicine in Mexico by Antonio Moreno Guzmán. Through them is given an integral vision of the state of health and illness during the administration of General Lázaro Cárdenas del Río, the first sexennial presidential government of the twentieth century. Several aspects are discussed, among them, the President's nationalist policy which led to an important distribution of land to the peasants. His education policy originated, among other things, the creation of the National Polytechnic Institute that framed two medical schools, the National Homeopathic Medicine and the Superior of Rural Medicine. The social service for medical interns of the UNAM was created. On the other hand, General Cárdenas placed special emphasis on preventive and care medicine. In addition to organizing campaigns against multiple diseases, including pox, typhus, tuberculosis, malaria, and sexually transmitted diseases, special attention was given to maternal and child care. An urgent problem was that of malnutrition, so special care was taken in the child and peasant population. Likewise, in order to attend to morbidity, in the period 1934-1940, general and specialty hospitals were set up under government, private, military, and private charitable institutions. The last study that is presented refers to the military health modernization initiatives initiated by General Cárdenas, that had repercussions on the health of the military and its successors.

The emergence of trust in clinics of alternative medicine.

Demands for alternative medicine have increased since the 1970s in nations in which western scientific evidence has become the basis for health care. This paradox has been the impetus to examine how trust emerges in clinics of alternative medicine. Alternative practitioners are self-regulated and the clients pay out of their own pockets to attend non-authorised treatments with very limited scientific evidence of their effects. Trust is a key issue in this context. However, only a few studies have dealt with the ways in which alternative practitioners win their clients' trust. Drawing on three qualitative studies and informing the empirical findings with a sociological concept of trust, this article provides new empirical insights on how trust emerges in Danish clinics of acupuncture, reflexology and homeopathy. The analysis demonstrates how trust is situational and emerges through both clients' susceptibility and practitioners' individual skill development and strategies, as well as from objects, place and space. Trust is developed on relational and bodily as well as material grounds. It is argued that the dynamics and elements of trust identified do not only minimalise uncertainties but sometimes convert these uncertainties into productive new ways for clients to address their ailments, life circumstances and perspectives.

Complementary and alternative medicine for cancer patients: results of the EPAAC survey on integrative oncology centres in Europe.

BACKGROUND: The Region of Tuscany Health Department was included as an associated member in WP7 "Healthcare" of the European Partnership for Action Against Cancer (EPAAC), initiated by the EU Commission in 2009. AIMS: The principal aim was to map centres across Europe prioritizing those that provide public health services and operating within the national health system in integrative oncology (IO). METHODS: A cross-sectional descriptive survey design was used to collect data. A questionnaire was elaborated concerning integrative oncology therapies to be administered to all the national health system oncology centres or hospitals in each European country. These institutes were identified by convenience sampling, searching on oncology websites and forums. The official websites of these structures were analysed to obtain more information about their activities and contacts. RESULTS: Information was received from 123 (52.1 %) out of the 236 centres contacted until 31 December 2013. Forty-seven out of 99 responding centres meeting inclusion criteria (47.5 %) provided integrative oncology treatments, 24 from Italy and 23 from other European countries. The number of patients seen per year was on average 301.2 ± 337. Among the centres providing these kinds of therapies, 33 (70.2 %) use fixed protocols and 35 (74.5 %) use systems for the evaluation of results. Thirty-two centres (68.1 %) had research in progress or carried out until the deadline of the survey. The complementary and alternative medicines (CAMs) more frequently provided to cancer patients were acupuncture 26 (55.3 %), homeopathy 19 (40.4 %), herbal medicine 18 (38.3 %) and traditional Chinese medicine 17 (36.2 %); anthroposophic medicine 10 (21.3 %); homotoxicology 6 (12.8 %); and other therapies 30 (63.8 %). Treatments are mainly directed to reduce adverse reactions to chemo-radiotherapy (23.9 %), in particular nausea and vomiting (13.4 %) and leucopenia (5 %). The CAMs were also used to reduce pain and fatigue (10.9 %), to reduce side effects of iatrogenic menopause (8.8 %) and to improve anxiety and depression (5.9 %), gastrointestinal disorders (5 %), sleep disturbances and neuropathy (3.8 %). CONCLUSIONS: Mapping of the centres across Europe is an essential step in the process of creating a European network of centres, experts and professionals constantly engaged in the field of integrative oncology, in order to increase, share and disseminate the knowledge in this field and provide evidence-based practice.

Is 'mainstreaming AYUSH' the right policy for Meghalaya, northeast India?

BACKGROUND: National policy on medical pluralism in India encourages the mainstreaming of AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) systems and the revitalization of local health traditions (LHT). In Meghalaya state in the northeast, the main LHT is its indigenous tribal traditional medicine. This paper presents the perceptions of tribal medicine and of AYUSH systems among various policy actors and locates the tribal medicine of Meghalaya within the policy on medical pluralism currently being implemented in the state, a region that is ethnically and culturally different and predominantly inhabited by indigenous peoples. METHODS: A stakeholder mapping exercise identified appropriate policy actors and 46 in-depth interviews were conducted with policy makers, doctors, academics, members of healer associations and elders of the community. A further 44 interviews were conducted with 24 Khasi and 20 Garo traditional healers. Interview data were supplemented with document analysis and observations. Qualitative data were analyzed using thematic content analysis that incorporated elements of grounded theory. RESULTS: In Meghalaya there is high awareness and utilization of tribal medicine, but no visible efforts by the public sector to support or engage with healers. The AYUSH systems in contrast had little local acceptance but promotion of these systems has led to a substantial increase in AYUSH doctors, particularly homeopaths, in rural areas. Policy actors outside the health department saw an important role for tribal medicine due to its popularity, local belief in its efficacy and its cultural resonance. The need to engage with healers to enhance referral, training, documentation and research of tribal medicine was made. CONCLUSIONS: The wide acceptance of tribal medicine suggests that tribal medicine needs to be supported. The results of the study question the process of the implementation of the 'mainstreaming AYUSH' policy for Meghalaya and highlight the importance of contextualizing health policy within the local culture. A potential role for Health Policy and Systems Research (HPSR) at sub-national levels is also highlighted.

Ethical and legal issues in cross-system practice in India: Past, present and future.

Recent changes in policies allowing practitioners of Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) to integrate into the mainstream of healthcare and also allowing practitioners of Ayurveda and Homoeopathy to perform medical termination of pregnancy (MTP) under the proposed amendment to the MTP bill have brought crosssystem practice into the limelight. We evaluate cross-system practice from its legal and ethical perspectives. Across judgments, the judiciary has held that cross-system practice is a form of medical negligence; however, it is permitted only in those states where the concerned governments have authorized it by a general or special order. Further, though a state government may authorize an alternative medicine doctor to prescribe allopathic medicines (or vice versa), it does not condone the prescription of wrong medicines or wrong diagnosis. Courts have also stated that prescribing allopathic medicines and misrepresenting these as traditional medicines is an unfair trade practice and not explaining the side-effects of a prescribed allopathic medicine amounts to medical negligence. Finally, the Supreme Court has cautioned that employing traditional medical practitioners who do not possess the required skill and competence to give allopathic treatment in hospitals and to let an emergency patient be treated by them is gross negligence. In the event of an unwanted outcome, the responsibility is completely on the hospital authorities. Therefore, there is an urgent need to abolish cross-system practice, invest in healthcare, and bring radical changes in health legislations to make right to healthcare a reality.

Unpacking intoxication, racialising disability.

This article examines concepts whose strictly medical applications have only partly informed their widespread use and suggests that demonstrably shared logics motivate our thinking across domains in the interest of a politically just engagement. It considers exchanges between the culturally complex concepts of 'toxicity' and 'intoxication', assessing the racialised conditions of their animation in several geopolitically--and quite radically--distinct scenarios. First, the article sets the framework through considering the racial implications of impairment and disability language of 'non-toxic' finance capital in the contemporary US financial crisis. Shifting material foci from 'illiquid financial bodies' to opiates while insisting that neither is 'more' metaphorically toxic than the other, the article turns to address the role of opium and temporality in the interanimations of race and disability in two sites of 19th-century British empire: Langdon Down's clinic for idiocy, and China's retort on opium to Queen Victoria. The article concludes with a provocation that suggests yet another crossing of borders, that between researcher and researched: 'intoxicated method' is a hypothetical mode of approach that refuses idealised research positions by 'critically disabling' the idealised cognitive and conceptual lens of analysis.

[The Seongho () School's Study of the Ancient Learning () and Its Influence on the Debate about Materia Medica in the Late Joseon Dynasty].

This study will determine the ways in which the ancient learning (gu xue, ) scholarship of the Seongho School, and its interest in the materia medica (ben cao xue, ) were related during the late Joseon period. The Seongho School centered its studies mainly on classical Chinese texts of the Han (206 BC－AD 220) and pre-Han (?－221 BC) (xian-qin lianghan, ) periods rather than those of the Tang and Song dynasties (618-1279). gu xue scholarship emerged during the Ming dynasty era (1368 －1644) as an alternative to the scholarly trends of the Song dynasty, which were dependent on Zhu Xi's (, 1130－1200) Neo-Confucianism and its interpretation of Han and pre-Han classical Chinese texts. This scholarly trend influenced Korean and Japanese literature, philosophy, and even medicine from the seventeenth through the nineteenth centuries. Focusing on Korean scholarship, we find a great deal of research regarding the influence of gu xue on Korean classical Chinese literature and Confucian philosophy in the late Joseon period; however, no study has examined how this style of scholarship influenced the field of medicine during the same period. This study will investigate how the intellectuals of the Seongho School, who did the most to develop gu xue among Joseon intellectuals, were influenced by this style of scholarship in their study of the materia medica. Jeong Yak-yong (1762－1836), the representative intellectual of the Seongho School, did not focus on complicated metaphysical medical theories, such as the Yin-Yang and Five Elements theory (yin yang wu xing shui, ) or the Five Movements and Six Atmospheres theory (wu yun liu qi shui, ). Instead, his interests lay in the exact diagnoses of diseases and meticulous herbal prescriptions which formed an essential part of the Treatise on Exogenous Febrile Disease (Shang han lun, ) written by Zhang Zhungjing (, 150－219) in the Han dynasty. The Treatise was compatible with the scholarly purpose of gu xue in that they both eschewed metaphysical explanations. The Seongho School's interest in the materia medica stemmed from a desire to improve the delivery and quality of medical practices in rural communities, where metaphysical theories of medicine did not prevail and the cost of medicine was prohibitive.

[Complementary and alternative medicine in the German outpatient setting: extent, structure and reasons for provision]. / Komplementäre und alternative Heilverfahren im vertragsärztlichen Bereich: Ausmaß, Struktur und Gründe des ärztlichen Angebots.

BACKGROUND: Research on complementary and alternative medicine (CAM) has mainly focused on CAM utilisation by patients. Fewer studies have analysed extent and structure of CAM provision or the reasons why physicians offer CAM as a therapeutic option in the outpatient setting. METHODS: A standardised questionnaire was developed addressing reasons and patterns of CAM provision. The questionnaire was sent by post to 2,396 general practitioners and specialists in 9 selected German districts. 553 physicians participated in the survey (23%). RESULTS: 63% of the respondents (n=350) answered that they had provided some sort of CAM to their patients within a period of 12 months preceding the study. The most frequently provided methods were acupuncture/traditional Chinese medicine, herbal remedies and homeopathy. In the sample, 90% of the orthopaedists were CAM providers, the highest rate among the participating disciplines. Several reasons for offering CAM were identified: conviction of therapeutic effectiveness regarding the patient's situation (68%), aspects of therapeutic freedom (47%) or less harmful side effects than conventional therapies (34%). 6% provide CAM for monetary reasons. CONCLUSION: Findings suggest that the provision of CAM is widespread in the German outpatient setting. However, it has to be taken into account that a selection bias may apply which may lead to an overestimation of CAM provision. Doctors' reasons to offer CAM are manifold; therapeutic reasons seem to outweigh economic motives.

Natural disasters, livelihood, and healthcare challenges of the people of a riverine island in Bangladesh: A mixed-method exploration.

BACKGROUND: Bangladesh's islands, because of their geographical location, frequently encounter crises like floods and river erosion, which pose significant threats to the residents' well-being and livelihoods. To delve into the effects of these disasters on livelihood and healthcare challenges, a mixed-method study was undertaken in a riverine-island near a major river of Bangladesh. METHODOLOGY: Between February 15th and February 28th, 2023, a cross-sectional study was conducted on an island in Bangladesh. The quantitative method involved conducting a survey of 442 households, with a total of 2921 participants. Additionally, 10 in-depth interviews and 10 key-informant interviews were conducted using semi-structured guidelines. Qualitative interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. Triangulation was employed in this study through the integration of qualitative and quantitative analysis, resulting in the presentation of findings that offer an in-depth comprehension of the phenomenon being investigated. RESULTS: River erosions and floods are common and recurring natural disasters that significantly impact the lives of the riverine island inhabitants. These disasters often disrupted their livelihoods, forced many residents to endure substandard living conditions or relocated during flood events. The island faced a low diagnostic prevalence of chronic diseases (e.g., 5.1% of adults were hypertension and 2.5% are diabetes) because of the absence of diagnostic facilities and a shortage of certified doctors. A significant number of chronic illness people in the community turned to alternative medicine sources (39.3%) such as homeopathy, Kabiraj, and Ayurvedic medicine, especially it gets increased during periods of natural disasters. Moreover, reproductive aged women revealed that 79.4% of them gave birth at home, with 6.0% of these home deliveries resulting in miscarriage or infant death. The destruction of crops, unstable job opportunities, an inadequate educational system, and a deficient healthcare delivery system exacerbated the hardships faced by the population affected by these disasters. CONCLUSION: The failure to seek treatment for chronic diseases and undiagnosed diseases is a significant health issue among the aging adults on the island. Island residents face the challenge of establishing effective prevention strategies for the well-being of older adults especially at the period of natural disasters. It is crucial for the government and non-governmental organizations (NGOs) to collaborate to prevent the negative effects of floods and river erosions. This should include efforts to enhance the quality of education, healthcare services, job opportunities, and financial assistance for rebuilding homes.

Well-being in chronic pediatric inflammatory rheumatic diseases: the experience of a French healthcare network.

OBJECTIVE: Current management of patients with pediatric rheumatic diseases (PRD) should aim at achieving the best possible well-being. To identify sociodemographic/clinical characteristics, needed paramedical services and school accommodations associated with well-being in patients at inclusion in a French health network Réseau pour les Rhumatismes Inflammatoires Pédiatriques (RESRIP) that supports coordination of the patient's health pathway. To evaluate the evolution of well-being over time in this patients benefiting from such support. METHODS: Patients > 3 years old enrolled in RESRIP (2013-2020) were included. At enrollment, data were collected on sociodemographic/clinical characteristics, ongoing medications, and paramedical and educational actions to be implemented by RESRIP. Well-being during the last 6 months was reported with a standardized questionnaire at enrollment and every 6 months. A well-being score was calculated with scores ranging from 0 to 18, 18 corresponding to absolute well-being. Patients were followed up from inclusion until June 2020. RESULTS: In total, 406 patients were included and followed up for 36 months on average: 205 juvenile idiopathic arthritis, 68 connective tissue diseases, 81 auto-inflammatory diseases and 52 other diseases. The well-being score did not differ between the groups and improved significantly, by 0.04 score units, every 6 months (95% confidence interval [0.03; 0.06]). At inclusion, use of homeopathy, need for implementation of hypnosis or psychological support, occupational therapy or for adjustment of school tests were associated with worse well-being score. CONCLUSION: Well-being seems associated more with the impact of chronic illness than the type of PRD underlining the importance of a comprehensive patient care.

Understanding the role of context in health policy implementation: a qualitative study of factors influencing traditional medicine integration in the Indian public healthcare system.

India's public health system aims to foster pluralism by integrating AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy) with mainstream biomedical care. This policy change provides an opportunity to explore the complexity of health system innovation, addressing the relationship between biomedicine and complementary or alternative medicine. Implementing health policy depends on local, societal, and political contexts that shape intervention in practice. This qualitative case study explores contextual features that have influenced AYUSH integration and examines the extent to which practitioners are able to exercise agency in these contexts. Health system stakeholders were interviewed (n = 37) and integration activities observed. The analysis identifies contextual factors in health administration, health facilities, community, and wider society which influence the integration process. In the administrative and facility spheres, pre-existing administrative measures, resource and capacity deficits limit access to AYUSH medicines and opportunities to build relationships between biomedical and AYUSH doctors. At the community and society levels, rural AYUSH acceptance facilitates integration into formal healthcare, while professional organisations and media support integrative processes by holding health services accountable. The findings also demonstrate how, amid these contextual influences, AYUSH doctors navigate the health system hierarchies, despite issues with system knowledge against a background of medical dominance.

Benefits of Homeopathic Complementary Treatment in Patients With Breast Cancer: A Retrospective Cohort Study Based on the French Nationwide Healthcare Database.

BACKGROUND: Complementary therapy in oncology aims to help patients better cope with the illness and side effects (SEs) of cancer treatments that affect their quality of life (QOL). This study aimed to assess the benefits of homeopathic treatment on the health-related QOL (HRQOL) of patients with non-metastatic breast cancer (BC) prescribed in postsurgical complementary therapy. PATIENTS AND METHODS: An extraction from the French nationwide healthcare database targeted all patients who underwent mastectomy for newly diagnosed BC between 2012 and 2013. HRQOL was proxied by the quantity of medication used to palliate the SEs of cancer treatments. RESULTS: A total of 98,009 patients were included (mean age: 61 ± 13 years). Homeopathy was used in 11%, 26%, and 22% of patients respectively during the 7 to 12 months before surgery, the 6 months before, and 6 months after. Thereafter, the use remained stable at 15% for 4 years. Six months after surgery, there was a significant overall decrease (RR = 0.88, confidence interval (CI)95 = 0.87-0.89) in the dispensing of medication associated with SEs in patients treated with ≥ 3 dispensing of homeopathy compared to none. The decrease appeared to be greater for immunostimulants (RR = 0.79, (CI)95 = 0.74-0.84), corticosteroids (RR = 0.82, (CI)95 = 0.79-0.85), and antidiarrheals (RR = 0.83, (CI)95 = 0.77-0.88). CONCLUSION: The study showed an increasing use of homeopathy in patients with BC following diagnosis. This use was maintained after surgery and seemed to play a role in helping patients to better tolerate the SEs of cancer treatments.

Utilization and costs of conventional and alternative pharmaceuticals in children: results from the German GINIplus and LISAplus birth cohort studies.

PURPOSE: The socioeconomic determinants for drug utilization, especially in children, have not been investigated sufficiently so far. The study's aim was the estimation of prevalences and determinants of conventional, homeopathic and phytotherapeutic drugs and expenditures. METHODS: Population-based data on drug utilization of 3,642 children in two German birth cohorts (GINIplus and LISAplus, 10-year follow-up) were collected using a self-administered questionnaire. For analysis, the reported drugs (use within the last four weeks) were classified into the therapeutic categories of 'conventional medicine', 'homeopathy', 'phytotherapy' and 'others'. Drug costs were estimated using pharmaceutical identification numbers. RESULTS: In all, 42.3% of the children reported drug use; 24.1% of the drugs were homeopathic and 11.5% were phytotherapeutic. The proportion of children who took at least one homeopathic remedy was 14.3%. Drugs prescribed by physicians were dominated by conventional medicine (76.5%), whereas in non-prescribed drugs, both homeopathy and conventional medicine accounted for 37% each. Boys (OR = 0.78) used less homeopathy than girls. Income showed only a weak influence. Education had a strong effect on the use of phytotherapy such that children of mothers with higher school education (>10 years vs. <10 years) used more phytotherapy (OR = 2.01). If out-of-pocket payments arose (n = 613), the mean was €20. On average, total drug expenditures summed up to €39 in 4 weeks for drug users if only clearly identifiable prices for drugs were considered (58% of all data). CONCLUSIONS: Utilization of homeopathy is common in children from the analyzed cohort. User profiles of homeopathy and phytotherapy differ from each other and should be analyzed separately.

Impact of physician preferences for homeopathic or conventional medicines on patients with musculoskeletal disorders: results from the EPI3-MSD cohort.

OBJECTIVE: The objective of this study was to assess the effect of physician practicing preferences (PPP) in primary care for homeopathy (Ho), CAM (Complementary and alternative medicines) with conventional medicine (Mx) or exclusively conventional medicine (CM) on patients with musculoskeletal disorders (MSDs), with reference to clinical progression, drug consumption, side effects and loss of therapeutic opportunity. METHODS: The EPI3-MSD study was a nationwide observational cohort of a representative sample of general practitioners (GP) and their patients in France. Recruitment of GP was stratified by PPP, which was self-declared. Diagnoses and comorbidities were recorded by GP at inclusion. Patients completed a standardized telephone interview at inclusion, one, three and twelve months, including MSD-functional scales and medication consumption. RESULTS: 1153 MSD patients were included in the three PPP groups. Patients did not differ between groups except for chronicity of MSDs (>12 weeks), which was higher in the Ho group (62.1%) than in the CM (48.6%) and Mx groups (50.3%). The twelve-month development of specific functional scores was identical across the three groups after controlling for baseline score (p > 0.05). After adjusting for propensity scores, NSAID use over 12 months was almost half in the Ho group (OR, 0.54; 95%CI, 0.38-0.78) as compared to the CM group; no difference was found in the Mx group (OR, 0.81; 95% CI: 0.59-1.15). CONCLUSION: MSD patients seen by homeopathic physicians showed a similar clinical progression when less exposed to NSAID in comparison to patients seen in CM practice, with fewer NSAID-related adverse events and no loss of therapeutic opportunity.