Knowledge, attitude and traditional practices towards epilepsy among relatives of PWE (patients with epilepsy) in Marrakesh, Morocco.

Epilepsy remains one of the most common neurological diseases in the world but seems to be widely misunderstood, especially in low-income countries. Patients with epilepsy (PWE) can face considerable stigma in society, and there have been various studies that evaluate the knowledge and attitude of the population towards epilepsy. However, there was no study of this kind in Morocco. PURPOSE: Our aim was thus to assess knowledge, attitudes, and traditional practices specifically among relatives and caregivers of PWE in our community, in order to better evaluate their educational needs. METHODS: This cross-sectional and descriptive study was carried out over a year long period in the outpatient neurology clinic of the Mohammed 6 University Hospital, a tertiary referral center in Marrakesh, Morocco. The respondents were relatives of PWE (usually parents and siblings) or spouses who attended the outpatient clinic alongside them. The interviews were carried out by the same investigator at the outpatient clinic during patient's visits, face-to-face using Moroccan Arabic or Darija, with an 18-item questionnaire. RESULTS: Responses of 100 participants were analyzed. The mean age was 40 years old and 5 months. Sixty-six percent of the respondents were women, 50% of rural origin and 76 % lived in an urban area. Forty-one percent were illiterate, and 74% were of low income. Only 65% of the participants knew the Arabic term for epilepsy. For 48%, epilepsy was linked with witchcraft or demonic possession. Seventy-five percent of the respondents had at least one prior consultation to a traditional healer. Only 5% in our study knew the first-aid basics to apply in case of a seizure. CONCLUSION: Despite having a relative with epilepsy, our participants' knowledge was very poor. The level of education and income seem to be the two major contributing factors. Cultural beliefs and superstition are very pervasive, and the majority of our sample had already used traditional healing and alternative medicine. Our study highlights the need for a more global intervention in Morocco encompassing healthcare policies, awareness campaigns, and educational reforms.

Listening to First Nations women' expressions of heart health: mite achimowin digital storytelling study.

Historically, heart health was approached holistically by First Nations (FN) peoples, which was integrated into daily living. Caring for the physical, emotional and spiritual needs of individuals, community, family, and the living environment was integral. The Truth and Reconciliation Commission of Canada demonstrates the decimation of health practices through governmental policy to destroy the cultural foundations of FN peoples. Relational systems and ways of living were outlawed, and the health of FN people suffered. A digital storytelling study collaborated with Manitoba FN women with lived experience of caring for a biomedical-diagnosed heart condition. The objective was to identify concepts, language, and experiences of heart health among FN women. Six women created five digital stories; four are available publically online. Themes addressed by the storytellers include: changes to diet and lifestyle, related health conditions, experiences with healthcare system, residential schools, and relationships with children and grandchildren. The intersection of Western and FN knowledges heard in the women's stories suggests heart health knowledge and care is embedded within historical and social contexts. Insights into the non-dichotomous relationship between FN and biomedical knowledge of heart health, along with their conceptualisations of heart, suggests historical and social roots underlying heart health issues First Nations women face.

Cultural Context of Family Religiosity/Spirituality among Korean-American Elderly Families.

The purpose of this study is to explore the cultural context of family religiosity/spirituality among Korean-American elderly families, and how this changed after families immigrated to the USA. Fifty one first-generation Korean-Americans participated in one or two hour, in-depth interviews in Korean at a participant's home or church. These included 27 older adults and 24 family members living together or within a radius of one-hour transit time from their elders, residing in the Southeastern United States. A thematic and interpretive method was used to analyze transcribed interviews. Three themes were identified that explained the cultural context of family religiosity/spirituality: (a) traditional family religious rituals, (b) church oriented routines, and (c) family collectivism. The participants did not distinguish 'religiosity' and 'spirituality' during the interviews. The findings suggest that the family religiosity/spirituality of the participants was influenced by the traditional family religious values, which were shaped by Korean culture. The traditional religions of Shamanism, Buddhism, and Confucianism are prevalent in Asian countries. Thus, the findings of this study may help healthcare professionals identify the cultural contexts of spirituality/religiosity of Asian immigrant families in order to provide holistic care.

Family Interdependence, Spiritual Perspective, Self-Transcendence, and Depression Among Korean College Students.

The purpose of this study was to examine the mechanisms that might account for the effects of spirituality and self-transcendence on Korean college students' depression among 197 Korean fathers, mothers, and children. A structural equation analysis indicated that spiritual perspective related to lower depression through the mediating pathway of self-transcendence for individuals. Mothers' spiritual perspective and self-transcendence related to their children's depression through the mediating pathway of their own depression, but the same was not true for fathers. Findings help explicate the intergenerational transmission of depression and important predictors of depression related to spirituality.

Caregiver-infant's feeding behaviours are associated with energy intake of 9-11 month-old infants in rural Ethiopia.

Inappropriate complementary feeding, both in quantity and quality, is a major determinant of undernutrition. However, little is known about how infant-caregiver's feeding behaviours affect infants' energy intake. Therefore, the objective of this study was to characterize infant-caregiver feeding behaviours and investigate their association with infants' energy intake. The study involved 106 mother-child pairs recruited from seven randomly selected kebeles of Mecha district, West Gojam, Ethiopia. The feeding styles were assessed through observations of 1-day, in-home, feeding episodes that were videotaped and coded into self-feeding, responsive, active, distracting, and social feeding behaviours. Infants' haemoglobin and anthropometric measurements were taken. The association between feeding behaviour scores and energy intake per meal was investigated. The mean food intake of the infants was very low (11.4 ± 7.0 g/kg body weight per meal) compared to the minimum theoretical gastric capacity (30 g/kg body weight per meal). Infants' haemoglobin concentration was negatively associated with energy intake (ρ = 0.178, p = .03). Infants' responsive and active positive feeding styles were positively associated with energy intakes (ρ = 0.258 and 0.432, p = .004 and p < .001, respectively) as well as caregivers' responsive positive feeding styles (ρ = 0.237, p = .007). Both haemoglobin concentrations and feeding styles were associated with infant's energy intake. Anaemia prevention and control measures should be reinforced. Current nutrition education programmes should give emphasis on ways to effectively incorporate culturally adapted responsive feeding messages in this and similar settings.

A Longitudinal Analysis of Antiretroviral Adherence Among Young Black Men Who Have Sex With Men.

PURPOSE: Young black men who have sex with men (YBMSM) experience poorer antiretroviral therapy (ART) medication adherence relative to their white counterparts. However, few studies have longitudinally examined factors that may correlate with various classifications of ART adherence among this population, which was the primary aim of this study. METHODS: Project nGage was a randomized controlled trial conducted across five Chicago clinics from 2012 to 2015. Survey and medical records data were collected at baseline and 3- and 12-month periods to assess whether psychological distress, HIV stigma, substance use, family acceptance, social support, and self-efficacy predicted ART medication adherence among 92 YBMSM ages 16-29 years. RESULTS: Major results controlling for the potential effects of age, education level, employment, and intervention condition indicated that participants with high versus low medication adherence were less likely to report daily/weekly alcohol or marijuana use, had higher family acceptance, and exhibited greater self-efficacy. CONCLUSIONS: These findings identity important factors that can be targeted in clinical and program interventions to help improve ART medication adherence for YBMSM.

Taiwanese medical students' narratives of intercultural professionalism dilemmas: exploring tensions between Western medicine and Taiwanese culture.

In an era of globalization, cultural competence is necessary for the provision of quality healthcare. Although this topic has been well explored in non-Western cultures within Western contexts, the authors explore how Taiwanese medical students trained in Western medicine address intercultural professionalism dilemmas related to tensions between Western medicine and Taiwanese culture. A narrative interview method was employed with 64 Taiwanese medical students to collect narratives of professionalism dilemmas. Noting the prominence of culture in students' narratives, we explored this theme further using secondary analysis, identifying tensions between Western medicine and Taiwanese culture and categorizing students' intercultural professionalism dilemmas according to Friedman and Berthoin Antal's 'intercultural competence' framework: involving combinations of advocacy (i.e., championing one's own culture) and inquiry (i.e., exploring one's own and others' cultures). One or more intercultural dilemmas were identified in nearly half of students' professionalism dilemma narratives. Qualitative themes included: family relations, local policy, end-of-life care, traditional medicine, gender relations and Taiwanese language. Of the 62 narratives with sufficient detail for further analysis, the majority demonstrated the 'suboptimal' low advocacy/low inquiry approach (i.e., withdrawal or inaction), while very few demonstrated the 'ideal' high advocacy/high inquiry approach (i.e., generating mutual understanding, so 'intercultural competence'). Though nearly half of students' professionalism narratives concerned intercultural dilemmas, most narratives represented disengagement from intercultural dilemmas, highlighting a possible need for more attention on intercultural competence training in Taiwan. The advocacy/inquiry framework may help educators to address similar disconnects between Western medicine and non-Western cultures in other contexts.

[Cultural interpretation of pain in family-oriented societies]. / Kulturelle Deutungen des Schmerzes in familienorientierten Gesellschaften.

Patients from different cultures, particularly from family-oriented societies, such as the Near and Middle East, southern Italy and Greece, have a different perception of pain and other healing expectations, even in contact with doctors, than for example patients in western societies. This aspect is not sufficiently taken into consideration by modern multimodal therapy approaches. The pain experienced is not limited to one part of the body but needs to be seen holistically in relation to the whole body. The limited access of patients to psychological complaints often leads to chronic pain or other physical complaints. For therapy and the therapist-patient relationship, it is essential to understand the significance of the pain experienced in the construction and experience of interpersonal relationships. The diseased body is an expression of the social, collective, economic, migrational history, mental and cultural state of mind of the patient; therefore, in the treatment of patients from traditional cultures a multimodal, interdisciplinary and culturally sensitive approach is necessary for effective pain treatment.

End-of-life preferences in Afro-Caribbean older adults: a systematic literature review.

Research suggests that older Blacks tend to prefer more aggressive treatment as they transition toward the end of life. African and Afro-Caribbean immigrants and their offspring are the fastest growing segments of the Black population in the United States. With the increasing population of Black older adults, the cost of end-of-life care is rising. This article presents a review of the literature on the end-of-life preferences of Afro-Caribbean older adults. Findings suggest that Afro-Caribbean older adults make end-of-life decisions with a significant emphasis on family structure, religion/spirituality, cultural identity, migration, and communication. Concerns regarding the meaning of end-of-life preparation and hospice are often viewed in ways that differ from that of healthcare providers. Future research is needed to investigate this process in the Afro-Caribbean older adult subset.

Self-transcendence, spiritual perspective, and sense of purpose in family caregiving relationships: a mediated model of depression symptoms in Korean older adults.

OBJECTIVES: This study used structural equation modeling to test the mediated model of late-life depression to understand the mechanisms that account for the direct and indirect effects of spiritual variables and purpose in life on depression within the context of Korean family caregiving relationships. METHOD: A secondary analysis study design used data from a study that tested a theory of family interdependence of 157 Korean elder-family caregiver dyads in Seoul, Korea. RESULTS: Both caregivers' and elders' self-transcendence was positively related to their own sense of purpose in life. However, only elders' spiritual perspective was related to purpose in life. Also, elders' purpose in life was positively associated with caregivers' purpose in life. Furthermore, there was a strong negative relationship between elders' purpose in life and their depressive symptoms, but there was not a significant negative relationship between caregivers' purpose in life and elders' depressive symptoms. Last, elders' purpose in life mediated the negative effects of elders' self-transcendence and spiritual perspective and of caregivers' self-transcendence and purpose in life on elders' depression. CONCLUSION: The findings suggest that purpose in life for both the caregiver and elder played an important role in elders' depression. Self-transcendence also was related to decreased depression in elders. It is suggested that more attention be given to caregiver and elder purpose in life in developing interventions to reduce or avoid elder depression in Korean elders.

Exploring occupation roles of hospice family caregivers from Maori, Chinese and Tongan ethnic backgrounds living in New Zealand.

A major challenge to occupational therapists working in palliative care is determining the best ways to help family caregivers who are caring for family members. The purpose of this study was to explore palliative caregiver occupations among Maori, Chinese and Tongan ethnicities. Six informants participated, one woman and one man from each ethnic group. In each of their homes, informants were asked to discuss what it was like caring for their dying family member. The occupational themes resulting from these interviews were food preparation, spirituality and family gathering. Therapists need to be aware of the differences in how people care for family members within their ethnicity. Implications are that occupational therapists can help families identify activities important to them within the main occupational themes: different types of foods and their preparations, various ways to express spirituality and how families gather together members of their extended family. Further, clinicians need to take on the role of a "not-knowing" but curious health-care provider in order to meet the needs of caregivers. The limitation was the small number of participants who all lived in one geographic area. Future studies should include a wider group of ethnicities.

Contribuição à psicanálise: irmãos e lutas fratricidas. psicossomática / Aporte al psicoanálisis: hermanos y lucha fratricida. psicosomática / Contributions to psychoanalysis: brothers and fratricidal struggle. psychosomatic

Neste artigo, veremos duas questões. Por um lado, a partir de Freud, sintetizo a perspectiva psicossomática, que considera que todos os seres humanos constituem uma unidade psicofísica e que todo o processo físico tem seu correlato afetivo específico. Como exemplo, destaco a importância do DNA mitocondrial, herdado somente da mãe. A outra questão que desenvolvo é seu correlato psíquico. Para isso, diferentemente de Freud, considero que a verdadeira horda primitiva é a família consanguínea (todos com todos, inclusive a própria mãe), e que – na filogenia – depois de se estabelecer a primeira proibição do incesto, começou a luta fratricida (todos contra todos). Estas marcas filogenéticas ganham força através da experiência ontogenética universal: estado pré-natal em e com a mãe, vinculo denominado siamês. O representante pós-natal dessa poderosa díade é a criança indômita. Nós a expressamos quando aspiramos restabelecer aquela segurança original, quando empreendemos lutas fratricidas para recuperar um lugar em e com equivalentes maternos (cônjuge, filhos, netos, líderes empresariais, institucionais, partidos políticos, etc.). Proponho adicionar às fases de desenvolvimento evolutivo o complexo prévio: estado siamês em e com a mãe-criança indômita-luta fratricida. E interpretar sua transferência em todas as biografias.

In this work I refer to two issues. First, from Freud, I synthesize a psychosomatic perspective, which considers that all human beings constitute a psychophysical unity and that every physical process has its specific affective correlate. As an example I focus on the importance of mitochondrial DNA, inherited only from the mother. The other issue is its psychical correlate. For this, unlike Freud, I rescue that the true primitive horde was the consanguineous family (everybody with everybody, even with their own mother). Thus – in the phylogeny – after establishing the first prohibition of incest, fratricide struggle began (all against all). These phylogenetic footprints gain strength by universal ontogenetic experience: prenatal state in and with mom, relationship that I call siamese. The postnatal representative of this powerful dyad is the indomitable child. We express it when we wish to restore that original security, when we establish fraternal struggles to regain a place in and with maternal equivalents (partners, children, grandchildren, business and institutional leaders, political parties, etc.). I propose to add in evolutionary developmental stages to this prior complex: siamese state in and with mom-indomitable child-fratricidal struggle. And interpret their transfer in all biographies.

En este trabajo me refiero a dos cuestiones. Por un lado, a partir de Freud sintetizo la perspectiva psicosomática que considera que todos los seres humanos constituimos una unidad psicofísica y que todo proceso físico posee su específico correlato afectivo. Como ejemplo me centro en la importancia del ADN mitocondrial, heredado solo por vía materna. Así, la otra cuestión que desarrollo es su correlato psíquico. Para eso, a diferencia de Freud, rescato que la verdadera horda primitiva fue la familia consanguínea (todos con todos, incluso la propia madre), y que – en la filogenia – luego de establecer la primera prohibición del incesto, comenzó la lucha fratricida (todos contra todos). Estas huellas filogenéticas cobran fuerza por la experiencia ontogenética universal: el estado prenatal en y con mamá, vínculo que denomino siamés. El representante postnatal de esta poderosa díada lo denomino niño indómito. Lo expresamos cuando aspiramos a restablecer aquella originaria seguridad, cuando establecemos luchas fraternas para reconquistar un lugar en y con equivalentes maternos (pareja, hijos, nietos, líderes empresariales, institucionales, partidos políticos, etc.). Propongo agregar en las fases del desarrollo evolutivo el complejo previo: estado siamés em y con mamá-niño indómito-lucha fratricida. E interpretar su transferencia en todas las biografias.

Contribuição à psicanálise: irmãos e lutas fratricidas. psicossomática / Aporte al psicoanálisis: hermanos y lucha fratricida. psicosomática / Contributions to psychoanalysis: brothers and fratricidal struggle. psychosomatic

Neste artigo, veremos duas questões. Por um lado, a partir de Freud, sintetizo a perspectiva psicossomática, que considera que todos os seres humanos constituem uma unidade psicofísica e que todo o processo físico tem seu correlato afetivo específico. Como exemplo, destaco a importância do DNA mitocondrial, herdado somente da mãe. A outra questão que desenvolvo é seu correlato psíquico. Para isso, diferentemente de Freud, considero que a verdadeira horda primitiva é a família consanguínea (todos com todos, inclusive a própria mãe), e que – na filogenia – depois de se estabelecer a primeira proibição do incesto, começou a luta fratricida (todos contra todos). Estas marcas filogenéticas ganham força através da experiência ontogenética universal: estado pré-natal em e com a mãe, vinculo denominado siamês. O representante pós-natal dessa poderosa díade é a criança indômita. Nós a expressamos quando aspiramos restabelecer aquela segurança original, quando empreendemos lutas fratricidas para recuperar um lugar em e com equivalentes maternos (cônjuge, filhos, netos, líderes empresariais, institucionais, partidos políticos, etc.). Proponho adicionar às fases de desenvolvimento evolutivo o complexo prévio: estado siamês em e com a mãe-criança indômita-luta fratricida. E interpretar sua transferência em todas as biografias. (AU)

In this work I refer to two issues. First, from Freud, I synthesize a psychosomatic perspective, which considers that all human beings constitute a psychophysical unity and that every physical process has its specific affective correlate. As an example I focus on the importance of mitochondrial DNA, inherited only from the mother. The other issue is its psychical correlate. For this, unlike Freud, I rescue that the true primitive horde was the consanguineous family (everybody with everybody, even with their own mother). Thus – in the phylogeny – after establishing the first prohibition of incest, fratricide struggle began (all against all). These phylogenetic footprints gain strength by universal ontogenetic experience: prenatal state in and with mom, relationship that I call siamese. The postnatal representative of this powerful dyad is the indomitable child. We express it when we wish to restore that original security, when we establish fraternal struggles to regain a place in and with maternal equivalents (partners, children, grandchildren, business and institutional leaders, political parties, etc.). I propose to add in evolutionary developmental stages to this prior complex: siamese state in and with mom-indomitable child-fratricidal struggle. And interpret their transfer in all biographies. (AU)

En este trabajo me refiero a dos cuestiones. Por un lado, a partir de Freud sintetizo la perspectiva psicosomática que considera que todos los seres humanos constituimos una unidad psicofísica y que todo proceso físico posee su específico correlato afectivo. Como ejemplo me centro en la importancia del ADN mitocondrial, heredado solo por vía materna. Así, la otra cuestión que desarrollo es su correlato psíquico. Para eso, a diferencia de Freud, rescato que la verdadera horda primitiva fue la familia consanguínea (todos con todos, incluso la propia madre), y que – en la filogenia – luego de establecer la primera prohibición del incesto, comenzó la lucha fratricida (todos contra todos). Estas huellas filogenéticas cobran fuerza por la experiencia ontogenética universal: el estado prenatal en y con mamá, vínculo que denomino siamés. El representante postnatal de esta poderosa díada lo denomino niño indómito. Lo expresamos cuando aspiramos a restablecer aquella originaria seguridad, cuando establecemos luchas fraternas para reconquistar un lugar en y con equivalentes maternos (pareja, hijos, nietos, líderes empresariales, institucionales, partidos políticos, etc.). Propongo agregar en las fases del desarrollo evolutivo el complejo previo: estado siamés em y con mamá-niño indómito-lucha fratricida. E interpretar su transferencia en todas las biografias. (AU)

Living and dying with dignity in Chinese society: perspectives of older palliative care patients in Hong Kong.

BACKGROUND: the empirical Dignity Model has profoundly influenced the provision of palliative care for older terminally ill patients in the West, as it provides practical guidance and intervention strategies for promoting dignity and reducing distress at the end-of-life. OBJECTIVE: to examine the concept of 'living and dying with dignity' in the Chinese context, and explore the generalisability of the Dignity Model to older terminal patients in Hong Kong. METHODS: using qualitative interviews, the concept of dignity was explored among 16 older Chinese palliative care patients with terminal cancer. Framework analysis with both deductive and inductive methods was employed. RESULTS: the three major categories of themes of the Dignity Model were broadly supported. However, the subtheme of death anxiety was not supported, while two subthemes of generativity/legacy and resilience/fighting spirit manifested differently in the Chinese context. Furthermore, four new emergent themes have been identified. They include enduring pain, moral transcendence, spiritual surrender and transgenerational unity. CONCLUSION: these findings highlight both a cultural and a familial dimension in the construct of dignity, underline the paramount importance of cultural awareness and competence for working with ethnically diverse groups, and call for a culturally sensitive and family oriented approach to palliative care interventions with older Chinese terminal patients.

Dignity amidst liminality: healing within suffering among Chinese terminal cancer patients.

This study critically examines the concepts of dignity and liminality at the end-of life, in an effort to better understand the processes of healing within suffering among Chinese terminal cancer patients receiving palliative care services in Hong Kong. Meaning-oriented interviews were conducted with 18 Chinese terminal patients, aged 44 to 98, to elicit the narratives and stories of their illness experience. All interviews were analyzed using grounded theory and supplemented by ethnographic observations and field notes. Two major themes and eight subprocesses of healing adopted by patients to achieve and maintain dignity were identified: (a) personal autonomy, which encompasses the need to (i) regain control over living environments, (ii) maintain self-sufficiency despite institutional care, (ii) make informed care decisions to reduce sense of burden, and (iv) engage in future planning to create a lasting legacy; and (b) family connectedness, which encompasses the need to (i) maintain close ties with family members to express appreciation, (ii) achieve reconciliation, (iii) fulfill family obligations, and (iv) establish a continuing bond that transcends generations. Implications of these themes for advanced care planning and life review interventions were discussed with the goal of enhancing patient autonomy and family connectedness, and thereby providing structure and meaning for Chinese terminal patients and their families at the end of life.

Multilevel modeling in psychosomatic medicine research.

The primary purpose of this study is to provide an overview of multilevel modeling for Psychosomatic Medicine readers and contributors. The article begins with a general introduction to multilevel modeling. Multilevel regression modeling at two levels is emphasized because of its prevalence in psychosomatic medicine research. Simulated data sets based on some core ideas from the Familias Unidas effectiveness study are used to illustrate key concepts including communication of model specification, parameter interpretation, sample size and power, and missing data. Input and key output files from Mplus and SAS are provided. A cluster randomized trial with repeated measures (i.e., three-level regression model) is then briefly presented with simulated data based on some core ideas from a cognitive-behavioral stress management intervention in prostate cancer.

Discussions on oral health care among elderly Chinese immigrants in Melbourne and Vancouver.

BACKGROUND: This study explored how elderly Chinese immigrants value and relate to how acculturation influences oral health and subsequent service use. METHODS: Elders who had immigrated to Melbourne and Vancouver within the previous 15 years were recruited from local community centres and assigned to focus groups of 5-7 participants in Vancouver (4 groups) or Melbourne (5 groups). RESULTS: Following an iterative process of thematic analysis, the discussions revealed that immigrants care about the comfort and appearance of their teeth, and they value Western dentistry as a supplement to traditional remedies, but they have difficulty getting culturally sensitive information about oral health care. Accessing dentistry, they explained, is distressing because of language problems and financial costs that impose on their children. Consequently, many immigrants obtain dental treatment in China when they return for occasional visits. They felt that separation of dentistry from national health care programmes in Canada and Australia disregards natural links between oral health and general health. CONCLUSIONS: The similarity of concerns in both cities suggests that dissemination of information and availability of services are the important themes influencing oral health, and that, beliefs developed over a lifetime play an important role in interpreting oral health in the host country.

Roadside memorials in northeastern Thailand.

In Thailand spirit houses are often established at places of fatal accidents, but these are generally anonymous. Personalized roadside memorials for accident victims are rare. This article analyses three roadside memorials, located on main roads in northeastern Thailand, in a comparative framework. Like in the contemporary West, such memorials commemorate a suddenly and violently killed person, but manifest a dynamics very different from that of Western roadside memorials: rather than private and temporary, these are permanent shrines, in which the spirit of the deceased is worshipped and supplicated by members of the public. The spirits and their shrines tend to become incorporated into the popular Thai magico-religious complex. While the literature offers a binary distinction between formal public monuments and informal, private and temporary (roadside) memorials, it is suggested that the informal, but public and permanent memorial shrines in Thailand exemplify a third type of edifices to commemorate the deceased in road accidents.