Cultural persistence and the 'herbal medicine paradox': Evidence from European data.

The use of herbal or traditional medicines has survived the proliferation of modern medicine. The phenomenon has been labeled as the 'herbal medicines paradox' (HMP). We study whether such HMP hypothesis can be explained by the persistence of attitudes across cultural boundaries. We undertake a secondary analysis of individual-level migration data to test the persistence of the use of herbal medicines in relation to norms in the person's country of birth (or home country). We study the association between attitudes towards herbal medicine treatments of both first (N = 3630) and second-generation (N = 1618) immigrants in 30 European countries, and the average attitudes of their sending country origins. We find robust evidence of an association that is stronger for the second-generation migrants. We document a stronger effect among maternal than paternal lineages, as well as significant heterogeneity based on migrants' country of origin. Our estimates are robust to different sample analysis. Our estimates are consistent with a cultural explanation for the HMP.

Using peer role-playing to improve students' clinical skills for musculoskeletal physical examinations.

BACKGROUND: The traditional curriculum for medical students in Japan does not include sufficient opportunities for students to develop their skills for musculoskeletal (MSK) examination and clinical reasoning and diagnosis. Therefore, an effective programme is required to help medical students and residents improve their clinical skills in MSK. This paper aims to assess the clinical skills of medical students who have participated in a peer role-playing simulation programme using a mini clinical evaluation exercise (mini-CEX). METHODS: Participants were 90 female medical students who were completing their first orthopaedic clinical clerkship. They were divided into two groups. The simulation group participated in a role-play focussed on MSK cases as low-fidelity simulation, a structured debriefing with the course supervisor, and a self-reflection on Day 1 (n = 64). The control group did not participate in the role-play due to randomised clerkship schedules (n = 26). On Day 2 of the intervention, we observed and assessed all participants' performances during MSK outpatient encounters using the mini-CEX. We compared the mini-CEX score between the simulation group and the control group; the Wilcoxon rank-sum test was used for statistical analysis. RESULTS: The mini-CEX scores for physical examination, clinical reasoning and diagnosis, and overall clinical competency were significantly higher in the simulation group than in the control group (p < .05, physical examination: p = .014, clinical reasoning: p = .042, overall: p = .016). These findings suggest that medical students who partake in a peer role-playing simulation programme could experience improved clinical skills for physical examination, clinical reasoning and diagnosis, and overall clinical competency in real-life MSK outpatient encounters. CONCLUSIONS: Through a mini-CEX assessment, our findings indicate that medical students who participated in our peer role-playing simulation programme have improved clinical skills. Peer role-playing as a low-fidelity simulation and practical educational opportunity will enable educators to polish the competency of medical students in musculoskeletal physical examinations and clinical reasoning and diagnosis in a clinical setting.

Does socio-economic status explain use of modern and traditional health care services?

Although socioeconomic status is acknowledged to be an important determinant of modern health care utilisation, most analyses to date have failed to include traditional systems as alternative, or joint, providers of care. In developing countries, where pluralistic care systems are common, individuals are likely to be using multiple sources of health care, and the order in which systems are chosen is likely to vary according to income. This paper uses self-collected data from households in Ghana and econometric techniques (biprobit modelling and ordered logit) to show that rising income is associated with modern care use whilst decreasing income is associated with traditional care use. When utilisation is analysed in order, results show rising income to have a positive effect on choice of modern care as a first provider, whilst choosing it second, third or never is associated with decreasing income. The effects of income on utilisation patterns of traditional care are stronger: as income rises, utilisation of traditional care as a first choice decreases. Policy should incorporate traditional care into the general utilisation framework and recognise that strategies which increase income may encourage wider utilisation of modern over traditional care, whilst high levels of poverty will see continued use of traditional care.

Revealing the popularity of traditional medicine in light of multiple recourses and outcome measurements from a user's perspective in Ghana.

Traditional medicine is known to be popular in sub-Saharan Africa, where over 80% have reported its utilization. It is claimed to be easily accessible, affordable, available and acceptable, but little is known about at which stage of treatment-seeking individuals turn to traditional medicines and the resulting satisfaction once used. This is due to a paucity of quantitative demand data on how many recourses of care people take for one episode of illness, whether individuals use traditional medicines as a secondary option to orthodox medicines, and if used, how satisfied they are with results. This study presents descriptive data from fieldwork carried out on 772 households in two regions of Ghana to ascertain actions taken for self-reported episodes of acute and previously diagnosed chronic diseases. Quantitative results that show by looking merely at first recourse, use of traditional medicines is fairly low, but once second recourses are accounted for there is a doubling and tripling of incidence of traditional medicine use for acute and chronic diseases, respectively. A commonly used patient-reported outcome measurement, the EuroQol 5 Dimension (EQ5D), is used to measure satisfaction before and after traditional medicine use, to reveal significantly positive changes. The study shows that whilst individuals are highly satisfied with traditional medicine, it is more often the second recourse of treatment with a revealed preference for orthodox medicines as a first recourse. This suggests that research is needed to investigate why individuals turn to traditional medicine only as a second recourse and to clarify the insufficiencies of orthodox treatment. Policies which guide individuals to take the most efficient recourses for given symptoms, and further exploration of key reasons behind high levels of satisfaction following utilization, are encouraged.