[Recent Trends of Trace Element Studies in Clinical Medicine in Japan].

The deficiency or excess intake of trace elements, including zinc, copper, selenium and iodine, has often been reported. Zinc deficiency is often observed in infants fed breast milk with low zinc concentration, individuals administered chelating medicines, athletes and patients with diabetes mellitus, hepatic cirrhosis or nephrosis syndrome. Menkes disease is associated with severe copper deficiency, and there is no effective treatment. Deficiencies of selenium and iodine are observed in patients who receive special formulas of milk and enteral formula with low selenium and iodine concentrations, respectively. In contrast, neonatal transient hypothyroidism due to excess intake of iodine in pregnant women has also reported in Japan. It is expected that collaborative studies by researchers and clinicians will contribute to clarify the detail mechanism, diagnosis and treatment of these abnormalities.

Global geriatric oncology: Achievements and challenges.

The aging of the population is a global challenge. The number of older adults is rapidly growing, leading to an increase in the prevalence of noncommunicable diseases associated with aging, such as cancer. Worldwide, older adults account for approximately half of all cancer cases, and this proportion is projected to increase globally. Furthermore, the majority of older adults live in less developed regions, where health systems are generally ill-equipped to provide care for complex chronic conditions. Worldwide, there is paucity of geriatric training, and most of the oncology workforce lacks the skills and knowledge to provide comprehensive care for older patients. Various initiatives aimed at providing adequate clinical care for older adults, increasing the geriatric skills and knowledge of healthcare professionals, and developing geriatric oncology research, have been successfully implemented. However, most developments in geriatric oncology have taken place in high-income countries, and there are still large inequalities in the availability of clinical, educational, and research initiatives across different regions of the world. This article provides an overview of geriatric oncology initiatives in Asia, Europe, Australia and New Zealand, Latin America, and the United States and Canada. Understanding the achievements and challenges of geriatric oncology around the world, and fostering international collaboration in research and training are essential for improving the care of all older adults with cancer.

Holistic integrative medicine: toward a new era of medical advancement.

Medicine has encountered unprecedented problems associated with changes in nature, society, and environment, as well as with new human quests for survival, longevity, and health. In the meantime, the development of medicine is facing challenges that resulted from the over-division and specialization of disciplines and the fragmentation of medical knowledge. To construct a new medical system that is more suitable for human health and disease treatment, holistic integrative medicine (HIM), which regards the human body as a holistic entity, organically integrates the most advanced knowledge and theories in each medical field and the most effective practices in various clinical specialties to revise and adjust on the basis of social, environmental, and psychological conditions. HIM is the inevitable and necessary direction for the future development of medicine. In this article, we illustrated the connotation of HIM, the differences between HIM and other medical conceptions, and the practice of HIM in recent years.

Contribuciones de la medicina psicosomática a la medicina clínica y preventiva / Contributions of psychosomatic medicine to clinical and preventive medicine

El trabajo ofrece una revisión actualizada de las principales contribuciones de la Medicina Psicosomática a la medicina clínica y preventiva. Su contenido se basa en los resultados de revisiones sistemáticas, metaanálisis y estudios controlados. La evidencia acumulada indica que la perspectiva psicosomática podría contribuir significativamente a mejorar los resultados de la atención sanitaria, mediante una práctica clínica holística, la evaluación de los factores psicosociales implicados en la vulnerabilidad individual y la integración de intervenciones psicológicas en medicina. Dicha evidencia constituye el terreno ideal para afrontar necesidades emergentes en sanidad, como la gestión de enfermedades crónicas y de síntomas inexplicables, el paciente como productor activo de salud, la prevención temprana y una valoración de resultados que supere el reduccionismo biomédico

This paper provides an updated review of the main contributions of Psychosomatic Medicine to clinical and preventive medicine. Metaanalyses, comprehensive reviews and controlled studies were selected. Current advances in the field indicate that health care can be improved by using a psychosomatic approach that takes into account psychosocial factors affecting individual vulnerability, the holistic consideration of patient care, and the integration of psychological interventions in medicine. Consolidated evidence in Psychosomatic Medicine provides the ideal background for dealing with new needs emerging in medical practice, including chronic illness management, somatic unexplained symptoms, the shift in the role of patients from health consumers to actively health producers, primary earlylife prevention, and the appraisal of health outcomes beyond the biomedical reductionism

How 'alternative' is CAM? Rethinking conventional dichotomies between biomedicine and complementary/alternative medicine.

The aim of this article is to interrogate the pervasive dichotomization of 'conventional' and 'alternative' therapies in popular, academic and medical literature. Specifically, I rethink the concepts such as holism, vitalism, spirituality, natural healing and individual responsibility for health care as taken-for-granted alternative ideologies. I explore how these ideologies are not necessarily 'alternative', but integral to the practice of clinical medicine as well as socially and culturally dominant values, norms and practices related to health and health care in Canada and elsewhere. These reflections address both theoretical and applied concerns central to the study of integration of different medical practices in western industrialized nations such as Canada. Overall, in examining homologies present in both biomedicine and complementary/alternative medicine (CAM), this article rethinks major social practices against binary oppositions by illustrating through literature review that the biomedical and CAM models may be homologous in their original inceptions and in recent cross-fertilizations towards a rigorous approach in medicine. By highlighting biomedicine and CAM as homologous symbolic systems, this article also sheds light on the potential for enhancing dialogue between diverse perspectives to facilitate an integrative health care system that meets multiple consumer needs.

Trends of increase in western medical services in traditional medicine hospitals in China.

BACKGROUND: Compare changes in types of hospital service revenues between traditional Chinese medicine (TCM) hospitals and Western-medicine based general hospitals. METHODS: 97 TCM hospitals and 103 general hospitals were surveyed in years of 2000 and 2004. Six types of medical service revenue between the two types of hospitals were compared overtime. The national statistics from 1999 to 2008 were also used as complementary evidence. RESULTS: For TCM hospitals, the percentage of service revenue from Western medicine increased from 44.3% to 47.4% while the percentage of service revenue from TCM declined from 26.4% to 18.8% from 1999 to 2004. Percentages of revenue from laboratory tests and surgical procedures for both types of hospitals increased and the discrepancy between the two types of hospitals was narrowed from 1999 to 2004. For TCM hospitals, revenues from laboratory tests increased from 3.64% to 5.06% and revenues from surgical procedures increased from 3.44% to 7.02%. General hospitals' TCM drug revenue in outpatient care declined insignificantly from 5.26% to 3.87%, while the decline for the TCM hospitals was significant from 19.73% to 13.77%. The national statistics from 1999 to 2008 showed similar trends that the percentage of revenue from Western medicine for TCM hospitals increased from 59.6% in 1999 to 62.2% in 2003 and 66.1% in 2008 while the percentage of revenue from TCM for TCM hospitals decreased from 18.0% in 1999, 15.4% in 2003, and 13.7% in 2008. CONCLUSION: Western medicine has become a vital revenue source for TCM hospitals in the current Chinese health care environment where government subsidies to health care facilities have significantly declined. Policies need to encourage TCM hospitals to identify their own special and effective services, improve public perception, increase demand, strengthen financial sources, and ultimately make contributions to preserving one of the national treasures.

[Biological reductionism and the medicine of the 21st century].

They were bothered by the fact that biological science, which was focusing on individual parts of the living systems in the hope that their knowledge should help understand the organization and principles of the living systems' existence, would be at a deadlock sooner or later. The development of fundamental molecular sciences proves them to be actually in a crisis. I would like to show, in this review, that the elevated expectations of a radical revolution in the field of fundamental biological sciences and in applied spheres, particularly, in practical medicine, which are due to the progress of high-effective technologies of the cell's molecular organization, especially the technologies designed for the sequencing of entire genomes, do not prove valid. These technologies cause the accumulation of vast amounts of information with no functional interpretation done. It starts to be comprehensible now that we advance at a painfully slow step to some successive stage on the path towards the answer to the essential question of biology -- What is Life? Moreover, understanding forms that we are advancing, equally slowly and painfully, along the path of progress in the field of medicine, especially so when it concerns the widely spread diseases, which are complex diseases. On this path, we often find ourselves at impasses with no way out, and although we witness the birth of a new biology -- the system biology, a synthetic one, constituting a unique alloy of many sciences, it is far from being definite that this new biology wouldalso answer this principal fundamental question and push forward the medical applications of genomics. Nonetheless, the accumulated information is very helpful and can be used for the elaboration of fundamental vetoes of biology [1] which will allow a considerable portion of the efforts in the practical, namely medical, area to be rejected as unrealizable, in the same way as the second principle of thermodynamics puts a ban on the creation of the perpetuum mobile. I am also trying to postulate that in the area of practice one should possibly think about the approaches directed to the eradication or substitution of ill cells or a damaged system's tissues, and not about the reductionistic approaches aimed at repairing the diseased organism's individual molecular components. I tried to demonstrate this statement using the example of cancer genetic surgerys. Employment of stem cells, including those modified by gene engineering, provides another instance of a holistic approach.

Espiritualidade na prática clínica: o que o clínico deve saber / Spirituality in clinical practice: what should the general practitioner know

JUSTIFICATIVA E OBJETIVOS: Estudos têm demonstrado que a espiritualidade pode promover efeitos positivos e negativos na saúde do paciente. Entretanto, os médicos possuem grande dificuldade para a abordagem deste assunto. O objetivo deste estudo foi rever o tema, focando nas necessidades dos clínicos.CONTEÚDO: Realizou-se um apanhado geral dos conhecimentos que o clínico deve possuir sobre os aspectos espirituais do paciente, dividindo-se nas seguintes partes: introdução, contexto histórico, conceitos básicos, por que o clínico deve abordar a espiritualidade do paciente, pesquisas e bases científicas, espiritualidade no meio acadêmico, quando e como deve ser abordada a espiritualidade/religiosidade, barreiras para o médico e os aspectos negativos da religião.CONCLUSÃO: O clínico deve saber o momento certo e a forma correta de se abordar essa dimensão, sem ofender ou julgar as preferências religiosas de cada paciente, de forma a exercer a Medicina de forma mais humana e integral possível.(AU)

BACKGROUND AND OBJECTIVES: Studies have shown that spirituality can promote positive and negative effects on health of the patient. However, doctors have great difficulty in approaching this issue. The objective of this study was to review the matter, focusing on the needs of general practitioners.CONTENTS: This is an overview of the knowledge that the clinician should have on the spiritual aspects of the patient, divided into the following parts: Introduction, Historic context, basic concepts, why the general practitioner must address spirituality with the patient, researches and scientific bases, spirituality in academic medicine, when and how spirituality should be addressed, physician barriers and the negative aspects of religion.CONCLUSION: The general practitioner must know the right time and right way of addressing the spiritual dimension, without judging and offending the religious preferences of each patient in order to make medicine more humanistic and integrative.(AU)

Enfermedades raras, un paradigma emergente en la medicina del siglo XXI / Rare diseases, an emergent paradigm in the medicine of the XXI century

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The transformation of osteopathic medical education.

Osteopathic medical schools and hospital-based postgraduate programs have long constituted small but important sources of physicians and surgeons, particularly for traditionally underserved areas of the United States. Though frequently marginalized in or even left out of standard histories and studies of U.S. medical education, these institutions have become much more difficult to ignore, given the rapid expansion of the number of osteopathic medical students in new and existing colleges and the size of their classes. By 2019, upwards of 25% of all U.S. medical school graduates produced annually will be doctors of osteopathic medicine. The author examines the process through which osteopathy was transformed into osteopathic medicine, how osteopathic medical schools achieved their present status as a significant source of U.S. graduates for residency training, and what challenges osteopathic medical education now faces.

Alternative medicine research in clinical practice: a US national survey.

BACKGROUND: Little is known about whether federally funded complementary and alternative medicine (CAM) research is translating into clinical practice. We sought to describe the awareness of CAM clinical trials, the ability to interpret research results, the acceptance of research evidence, and the predictors of trial awareness among US clinicians. METHODS: We conducted a cross-sectional mailed survey of 2400 practicing US acupuncturists, naturopaths, internists, and rheumatologists. RESULTS: A total of 1561 clinicians (65%) responded. Of the respondents, 59% were aware of at least 1 major CAM clinical trial; only 23% were aware of both trials. A minority of acupuncturists (20%), naturopaths (25%), internists (17%), and rheumatologists (33%) were "very confident" in interpreting research results (P < .001). Fewer acupuncturists (17%) and naturopaths (24%) than internists (58%) and rheumatologists (74%) rated the results of randomized controlled trials as "very useful" (P < .001). Twice as many internists (53%) and rheumatologists (64%) rated patient preferences as "least important" compared with acupuncturists (27%) and naturopaths (31%) (P < .001). In multivariate analyses, for clinicians aware of at least 1 trial, male sex (odds ratio [OR], 1.30 [95% confidence interval {CI}, 1.05-1.62]), prior research experience (OR, 1.45 [95% CI, 1.13-1.86]), institutional or academic practice setting (ORs, 1.98 [95% CI, 1.01-3.91], and 1.23 [95% CI, 0.73-2.09], respectively), and rating randomized trials as "very useful" (OR, 1.46 [95% CI, 1.12-1.91]) (P < .001) for clinical decision making were positively associated with CAM trial awareness. Acupuncturists, naturopaths, and internists (ORs, 0.15 [95% CI, 0.10-0.23], 0.15 [95% CI, 0.09-0.24], and 0.18 [95% CI, 0.12-0.28], respectively) were all similarly less aware of CAM trial results compared with rheumatologists. CONCLUSION: For clinical research in CAM to achieve its social value, concerted efforts must be undertaken to train clinicians and improve the dissemination of research results.

Estratégias terapêuticas no tratamento da dor crônica: uma genealogia da clínica da dor / Therapeutic strategies in the treatment of chronic pain: a genealogy of the pain clinic

O objetivo desse trabalho é analisar a singularidade das estratégias terapêuticas introduzidas pelo modelo das Clínicas da Dor, através de um estudo genealógico desse projetoterapêutico e sua contextualização no âmbito da racionalidade científica moderna. Mais especificamente, pretende-se analisar as transformações na racionalidade médica que permitiram, sucessivamente, a apreensão da dor pelo discurso médico, a concepção da dorcomo uma doença e a construção e a consolidação do modelo terapêutico das Clínicas da Dor. Para tal, inicialmente, analisamos o modelo terapêutico desenvolvido pelo médico anestesista John Bonica, idealizador do modelo das Clínicas da Dor, destacando as ferramentas conceituais que possibilitaram a compreensão da dor crônica como doença e como fenômenobiopsicossocial. Num segundo momento, realizamos uma descrição e análise dos principais eventos que permitiram a consolidação da medicina da dor como uma prática específica e multidisciplinar, dando destaque à inserção deste modelo no contexto do Sistema Único de Saúde Brasileiro. Finalmente, a partir de uma experiência clínico-institucional buscamos refletir sobre os limites e possibilidades da aplicação prática deste modelo, lançando luz sobre os impasses da clínica e tensões oriundas da problematização do dualismo mente e corpo e das práticas terapêuticas interdisciplinares.

Integrative medicine: a tale of two clinics.

BACKGROUND: Integrative medicine (blending the best of complementary and alternative medicine (CAM) with conventional medicine) is becoming increasingly popular. OBJECTIVES: The objectives of this paper are to compare and contrast the development of two teams that set out to establish integrative medical clinics, highlighting key issues found to be common to both settings, and to identify factors that appear to be necessary for integration to occur. METHODS: At St Michael's Hospital (an inner-city teaching hospital in Toronto, Canada), a total of 42 interviews were conducted between February 2004 and August 2006 wi18 key participants (4 administrators, 2 chiropractors, 2 physiotherapists and 10 family physicians). At the CARE (Complementary and Alternative Research and Education) Program at Stollery Children's Hospital, Edmonton, Canada, 44 interviews were conducted with 24 people on four occasions: June 2004, March 2005, November 2006, and June 2007. Basic content analysis was used to identify the key themes from the transcribed interviews. RESULTS: Despite the contextual differences between the two programs, a striking number of similar themes emerged from the data. The five most important shared themes were: 1) the necessity of "champions" and institutional facilitators to conceive of, advocate for, and bring the programs to fruition; 2) the credibility of these champions and facilitators (and the credibility of the program being established) was key to the acceptance and growth of the program in each setting; 3) the ability to find the "right" practitioners and staff to establish the integrative team was crucial to each program's ultimate success; 4) the importance of trust (both the trustworthiness of the developing program as well as the trust that developed between the practitioners in the integrative team); and 5) the challenge of finding physical space to house the programs. CONCLUSION: The programs were ultimately successful because of the credibility of the champions, institutional facilitators and the staff members. Selection of excellent clinicians who were able to work well as a team facilitated the establishment of trust both within the team itself as well as between the team and the host institution.