Submitted in fulfilment of the requirements for the Degree Philosophiae Doctor in Health Sciences, Durban University of Technology, 2017. / Background Cancer is a global concern because it affects and kills millions of people worldwide. In South Africa, patients frequently move between traditional health practitioners and radiation oncologists to seek cure of cancer, yet these health practitioners do not communicate with each other. Consequently, the treatment is often disrupted and imcomplete therefore compromising the survival of patients. The future of the health system in effective treatment of patients with cancer is dependent on health practitioners’ changing fundamentally in their co-operative practice. The aim of this study was to explore the practice of traditional health practitioners in the treatment of patients with cancer in order to describe a viable co-operative practice between them and radiation oncologists and ultimately develop traditional health practitioners as a component in the health system in the treatment of patients with cancer. Methods An exploratory descriptive qualitative study using an interpretive phenomenological approach was employed to collect data from 28 traditional health practitioners and four radiation oncologists in KwaZulu-Natal utilising snowball and stratified purposive samplings for the former and latter, respectively. Semi-structured face-to-face and group interviews were employed to collect primary data from traditional health practitioners and data from the radiation oncologists were collected through face-to-face and email interviews. Data were transcribed verbatim and analysed using framework analysis. Results It emerged that the referral of patients, in addition to external conditions, individual attributes, trusting attitudes of participants as well as organisational dynamics and philosophy of practice, were the main categories used by participants in their understanding of co-operative practice in KwaZulu-Natal. The patient is the main player in the co-operation between parties, and coordinates the health practitioners’ activities during treatment. Effective co-operative practice is time consuming and requires commitment, co-operation and training of the participants. Conclusion Considering the problems associated with treatment of cancer when patients move freely between the traditional health practitioners and radiation oncologists, resulting in interruptions in treatment, co-operative practice between the two health practitioners is paramount. The development of traditional health practitioners could result in extending their role in the management of cancer and therefore increasing the accessibility of cancer services. It follows that a workable practice between traditional health practitioners and radiation oncologists in the treatment of patients with cancer could be an inclusive health system where the parties work in parallel with the patient being the main actor in the collaboration. There should be a healthy relationship between all those involved in the collaboration in order to facilitate referral of patients between the health practitioners. / D

Philosophiae Doctor - PhD / The present healthcare system in South Africa suffers from a number of serious deficiencies. Whilst orthodox bio-medicine is well established in most first world countries, its total introduction and implementation into all communities within South Africa faces many obstacles. The cost of diagnostic techniques, investigative procedures and pharmaceutical products, the availability of competent medical staff in the non-urban areas, and the lack of acceptance of the philosophy and practice of orthodox bio-medicine in rural regions are but some of the factors which conspire against the general application of this orthodox medical paradigm. Another problem confronting healthcare and medical practice in South Africa, particularly at this stage of our historical development, is the absolute focus on orthodox bio-medicine, often to the detriment of other medical paradigms that also have advantages to offer. Can the integration of another medical paradigm, such as Unani-Tibb, enhance the practice of orthodox bio-medicine in this country?The aim of the thesis was to investigate the possibility of integrating Unani-Tibb with orthodox biomedicine (also termed conventional, Western or allopathic medicine) and assess its potential for improving delivery of an effective, affordable and appropriate healthcare system in South Africa.The research questions which the thesis seeks to answer is whether this integration is possible and whether the delivery of healthcare to the South African population can be enhanced. Changes in the provision of medical education are necessary, and occupy a pivotal role in allowing for this integration. Unani-Tibb is a traditional medical system practiced extensively on the Indian sub-continent and in other parts of the world. At present, however, it is minimally practiced in South Africa. Its primary principle is the energetic promotion of health maintenance behaviour and the prevention of disease, through effective application of dietotherapy, pharmacotherapy and other interventions, as well as the empowerment of the patient towards adopting behavioural changes and lifestyle adaptations. One positive aspect of Unani-Tibb is that it has many features in common with both orthodox biomedicine and African Traditional medicine. These commonalities should allow for greater acceptance by orthodox healthcare professionals, as well as the general population. The first part of the study involved the research and conceptualisation required for the production of a series of customized training modules which introduced the theory and practice of Unani-Tibb. A twelve month part-time training programme based on these modules was subsequently conducted with a number of healthcare professionals presently in active practice and with a background of orthodox medical or nursing healthcare. This outcomes-based training programme included a number of specifically designed training activities, such as case studies, practical exercises and assignments. Appropriate evaluations and assessments were pursued in order to measure performance outcomes and attitudes. Questionnaires for assessing the motivation and satisfaction of the participants were also completed. The second part of the study was in the form of a pilot participant research project, in which the participants applied the information from the integrative programme to a number of chronically ill patients who had previously been treated with standard orthodox bio-medical procedures. The parameters derived for clinical efficacy, cost-benefit and improvement in Quality of Life from Unani-Tibb treatment were then compared to equivalent results obtained by orthodox bio-medicine. In all parameters inspected, the integrative training programme compared favourably to orthodox bio-medical practice. Not only was there an improved clinical efficacy, but the cost-benefit was shown to be superior in most indices measured. The Quality of Life comparison, which assessed the patient and total health status, subjective behaviour and attitude, generally favoured the integrative training programme. The thesis serves to suggest that the integration of Unani-Tibb into orthodox bio-medical training in South Africa is a distinct possibility, and could ultimately allow for treatment which is clinically acceptable, cost-effective and which provides an improved Quality of Life for the population as a whole. I suggest that this pilot study be repeated more extensively, thereby allowing for a more confident and objective assessment. / South Africa

Introduction Traditional Chinese Medicine (TCM) is an ancient medical practice, performed since approximately 2000 B.C. Qigong constitutes one of five main pillars in TCM and is a method of meditation, exercise as well as self-medication. Basic tenets of TCM is the body existing in balance with Qi (life-energy) and its emphasis on holistic dynamic processes over material structure. A lot of research has been done on the positive health effects of Qigong, although it is unclear whether the evidence situation is judged to be sufficient to prove Qigong effective. Objective To investigate the arguments for and against acceptance of Qigong in Swedish Healthcare Methods This is a qualitative study that followed the hermeneutical method, as well as the normative ethical theory, of study-design and data analysis. Searches of grey literature and electronic databases (Pubmed, Cochrane) were performed, serving the purpose to collect different perspectives. The selection of sources was based on relevance to the aim. Data emerged was analysed in order to investigate the most relevant ethical arguments for and against integration of Qigong in the Swedish healthcare. Results Main arguments against acceptance of Qigong were: “Traditional Chinese Medicine’s underlying philosophy stand in opposition to scientific worldview”, “Lack of strong evidence”, “Complementary and Alternative Medicine lead people away from Evidence Based Medicine”, and “Economical incentive and bias in Complementary and Alternative Medicine and Qigong”.Main arguments for acceptance of Qigong were: “Extensive proven experience”, “Further acceptance and integration may increase patient safety and promote research”, and “Qigong is risk-free and highly available at low cost” Conclusion A strong argument against acceptance of Qigong is “lack of strong evidence”. Strong arguments for acceptance of Qigong are “further acceptance and integration may promote research” and “Qigong is risk-free and highly available at low cost”. Thus, strong arguments are found for, as well as against, integration of Qigong in Swedish established healthcare. The balance between these strong arguments, however, will have to be discussed further, as there is no obvious right answer.

The thesis is comprised of three separate studies that each relate to one of the aforementioned therapy types: complementary, alternative, and integrative medicine (CAIM), natural health products (NHPs), and medical cannabis. Parallels can be drawn across these therapy types in general including patient preference and prevalence of use, quality of patient health information, and safety and effectiveness concerns. Knowledge of these parallels both informed the development of these three studies and emerged across findings. Chapter 1 provides a comprehensive introduction to these parallels in the context of CAIM, NHPs, and medical cannabis. Chapter 2 comprises a cross-sectional survey determining NHP use disclosure to primary care physicians among patients attending a Canadian naturopathic clinic. Chapter 3 comprises a qualitative interview study identifying attitudes towards medical cannabis among family physicians practicing in Ontario, Canada. Chapter 4 comprises a sentiment analysis of Twitter data to understand how CAIM is mentioned during the COVID-19 pandemic. Lastly, chapter 5 serves as the conclusion of this thesis, and summarizes the most important findings, addresses study strengths and limitations, and discusses future directions from this work. / Thesis / Doctor of Philosophy (PhD)

BACKGROUND: All human societies have developed ways of maintaining health, dealing with illness and injury in ways that conform to their culture and environment. People worldwide draw upon a variety of healing systems, therapeutic methods, practices, and products, often referred to as Traditional and Complementary Medicine (T&CM). The World Health Organization (WHO) has encouraged member states to develop national policies that advance the integration of T&CM in national healthcare systems to harness their potential contribution to health, wellness, and people-centered health care. Yet, no global guidelines have been developed for assisting countries in structuring and developing such policies, and little is known about the characteristics of existing T&CM policies in Latin America and their level of implementation. METHODS: A qualitative research design was used to conduct a landscape analysis characterizing existing therapeutic pluralism policies in Latin American countries through a comprehensive literature review, a policy focused qualitative content analysis, key informant interviews and a case study analyzing the formulation process of Brazil's National Policy for Integrative and Complementary Health Practices (PNPICS). A technical cooperation tool to guide T&CM policy development and revision for Latin American countries was refined through face validation and an expert consensus method (Delphi process). Data categorization and analysis were performed in MS Excel and NVivo, using deductive and inductive coding. RESULTS: A total of 74 T&CM policy documents from the 16 Latin American countries were identified and characterized according to policy mechanisms. A typology of Latin American policy approaches identified policies as: health services-centered, model of care-based, participatory, and indigenous people-focused. Selection of T&CM practices for policy inclusion vary across countries; criteria change over time in Brazil might have compromised PNPICS’ political status. Lack of PNPICS financing jeopardized its implementation. A technical cooperation tool for T&CM policy development was structured on the policy cycle: national situation analysis, policy formulation, policy implementation, policy monitoring and evaluation, and policy re-formulation, re-prioritization for incremental policy developments. CONCLUSION: With a few exceptions, therapeutic pluralism policy implementation in Latin America seems to be a real challenge, often reducing policies to cultural and political symbols. Continued research is needed on assessing the various stages of the policy process in T&CM. / 2023-09-10T00:00:00Z

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<p>The present healthcare system in South Africa suffers from a number of serious deficiencies. Whilst orthodox bio-medicine is well established in most first world countries, its total introduction and implementation into all communities within South Africa faces many obstacles. The cost of diagnostic techniques, investigative procedures and pharmaceutical products, the availability of competent medical staff in the non-urban areas, and the lack of acceptance of the philosophy and practice of orthodox bio-medicine in rural regions are but some of the factors which conspire against the general application of this orthodox medical paradigm.<br /> <br /> Another problem confronting healthcare and medical practice in South Africa, particularly at this stage of our historical development, is the absolute focus on orthodox bio-medicine, often to the detriment of other medical paradigms that also have advantages to offer. Can the integration of another medical paradigm, such as Unani-Tibb, enhance the practice of orthodox bio-medicine in this country?<br /> <br /> The aim of the thesis was to investigate the possibility of integrating Unani-Tibb with orthodox biomedicine (also termed conventional, Western or allopathic medicine) and assess its potential for improving delivery of an effective, affordable and appropriate healthcare system in South Africa.<br /> <br /> The research questions which the thesis seeks to answer is whether this integration is possible and whether the delivery of healthcare to the South African population can be enhanced. Changes in the provision of medical education are necessary, and occupy a pivotal role in allowing for this integration. Unani-Tibb is a traditional medical system practiced extensively on the Indian sub-continent and in other parts of the world. At present, however, it is minimally practiced in South Africa. Its primary principle is the energetic promotion of health maintenance behaviour and the prevention of disease, through effective application of dietotherapy, pharmacotherapy and other interventions, as well as the empowerment of the patient towards adopting behavioural changes and lifestyle adaptations. One positive aspect of Unani-Tibb is that it has many features in common with both orthodox biomedicine and African Traditional medicine. These commonalities should allow for greater acceptance by orthodox healthcare professionals, as well as the general population. The first part of the study involved the research and conceptualisation required for the production of a series of customized training modules which introduced the theory and practice of Unani-Tibb. A twelve month part-time training programme based on these modules was subsequently conducted with a number of healthcare professionals presently in active practice and with a background of orthodox medical or nursing healthcare. This outcomes-based training programme included a number of specifically designed training activities, such as case studies, practical exercises and assignments. Appropriate evaluations and assessments were pursued in order to measure performance outcomes and attitudes. Questionnaires for assessing the motivation and satisfaction of the participants were also completed. The second part of the study was in the form of a pilot participant research project, in which the participants applied the information from the integrative programme to a number of chronically ill patients who had previously been treated with standard orthodox bio-medical procedures. The parameters derived for clinical efficacy, cost-benefit and improvement in Quality of Life from Unani-Tibb treatment were then compared to equivalent results obtained by orthodox bio-medicine. In all parameters inspected, the integrative training programme compared favourably to orthodox bio-medical practice. Not only was there an improved clinical efficacy, but the cost-benefit was shown to be superior in most indices measured. The Quality of Life comparison, which assessed the patient&rsquo / s total health status, subjective behaviour and attitude, generally favoured the integrative training programme. The thesis serves to suggest that the integration of Unani-Tibb into orthodox bio-medical training in South Africa is a distinct possibility, and could ultimately allow for treatment which is clinically acceptable, cost-effective and which provides an improved Quality of Life for the population as a whole. I suggest that this pilot study be repeated more extensively, thereby allowing for a more confident and objective assessment.</p>

Introdução: As práticas integrativas e complementares em saúde (PIC), entre as quais se inclui a acupuntura, vêm ganhando espaço nas últimas décadas no serviço público no Brasil. Em 2006 foi aprovada a lei que regulamenta a Política Nacional de Práticas Integrativas e Complementares (PNPIC), proporcionando maior impulso para essas práticas no SUS. Alinhada com essa política, a Unidade de Medicinas Tradicionais (UMT), no município de São Paulo, vem oferecendo desde 2005 atendimento com as PIC de maneira ampla e contínua. Entre os pacientes atendidos na UMT, há uma parcela de pacientes HIV positivos, cujo perfil é desconhecido. Objetivo: Descrever o perfil dos pacientes atendidos na Unidade de Medicinas Tradicionais e, em particular, dos pacientes HIV positivos, caracterizando: origem do encaminhamento, queixas, expectativas em relação ao tratamento e aspectos que mais influenciam negativamente a qualidade de vida desses pacientes. Métodos: Foi realizado um estudo transversal descritivo, analisando-se todos os prontuários dos pacientes atendidos na UMT entre 2006 e 2009. Os pacientes HIV positivos foram identificados e contatados para entrevista, para que informações detalhadas fossem obtidas. Foram usados um questionário de qualidade de vida específico para pacientes HIV positivos (HIV/AIDS-Targeted Quality of Life Instrument HAT-QoL) e um questionário desenvolvido pelo pesquisador. Resultados Foram incluídos 1960 pacientes, dos quais 81 por cento eram mulheres; 68,3 por cento acima dos 50 anos; e 74,1 por cento com demanda espontânea. As queixas principais foram dor (66 por cento ) e queixas mentais (26 por cento ), com duração mediana de 24 meses. Foram identificados 57 pacientes soropositivos, dos quais 71,9 por cento eram do sexo masculino. As queixas principais também foram dor (22 por cento ) e queixas mentais (21,3 por cento ), sendo 72,1 por cento com demanda espontânea. Entre as expectativas, estavam: alívio das queixas, melhora da qualidade de vida, bem-estar e melhora da imunidade. Na avaliação das dimensões de qualidade de vida, as mais afetadas foram função sexual e preocupação em revelar a doença. Conclusões: A população atendida na UMT é predominantemente feminina, acima dos 50 anos, com queixas álgicas, de longa duração e com demanda espontânea. Os pacientes HIV positivos são predominantemente masculinos. A principal queixa foi dor. Em sua maioria, procuraram atendimento em acupuntura de maneira espontânea. Esperavam, com o tratamento, o alívio das queixas, bem-estar, melhorar qualidade de vida e imunidade / Introduction: Integrative and Complementary Health Practices, among them acupuncture, have been gaining space in the last decades in the Brazilian Heath Pub lic System (SUS). In 2006, a law regulating the Integrative and Complementary Health Practices National Policy was passed, which boosted the implementation of such practices in the Health Public System. Aligned to that policy, the Tradition al Medicine Unit (UMT) in the city of São Paulo has been broadly and continually providing treatment based on Integrative and Complementary Health Practices since 2005. Among the patients treated at that unit, there are HIV-positive patients, whose profile is unknown so far. Objective: The aim of this study is to describe the profile of the patients treated at the UMT, particularly those who are HIV positive. The origin of the patients seen in the unit, their complaints, expectations regarding the treatment, and the aspects that might negatively influence their quality of life were described. Methods: We conducted a cross-sectional descriptive study by analyzing all medical charts from the patients treated at the Traditional Medicine Unit, from 2006 to 2009. The HIV-positive patients were identified and interviewed to obtain detailed information. The HIV/AIDS-Targeted Quality of Life Instrument HAT-QoL and a questionnaire prepared by the researcher were used. Results: The study included 1,960 patients, of which 81 per cent were women, 68.3 per cent were over 50 years of age, and 74.1 per cent arrived at the unit spontaneously. The main complaints were pain (66 per cent ) and mental disorders (26 per cent ), with average duration of 24 months. Fifty-seven HIV-positive patients were identified, of which 71.9 per cent were men; the main complaints were also pain (22 per cent ) and mental disorders (21.3 per cent ); 72.1 per cent arrived at the unit spontaneously. Among their expectations were: relief from complaints, improvement of their quality of life, well-being, and immunity. When the quality-of-life dimensions were evaluated, the sexual function and the concern about revealing the disease were the most affected ones. Conclusions: The population treated by the UMT is composed mostly by women, patients over 50 years of age, with long-term pain-related complaints, originating from spontaneous demand. The HIV-positive patients are mostly men whose prevailing complaint is pain. They have mostly sought acupuncture treatment spontaneously. They were expecting relief from complaints, and well-being, quality of life, and immunity improvement

Diabetes é um problema de saúde pública. Métodos que identifiquem precocemente a predisposição para a doença devem ser investigados. Iridologistas afirmam que o Sinal do Pâncreas e a Cruz de Andréas sugerem predisposição para diabetes. Os objetivos deste trabalho foram verificar a prevalência destes sinais em indivíduos com e sem a doença bem como sua herdabilidade. A coleta de dados ocorreu entre fevereiro de 2010 e junho de 2011. Participaram 356 indivíduos com idade superior a 30 anos. Indivíduos com diabetes apresentaram maior prevalência dos sinais iridológicos estudados. Os testes t de Student apontam diferença estatisticamente significativa na prevalência desses sinais entre pacientes com e sem diabetes e entre indivíduos com e sem antecedentes familiares para a doença. O Chi Quadrado demonstra que ter ambos os sinais aumenta a chance de desenvolvê-la. O coeficiente de correlação de Pearson aponta que os sinais estudados têm correlação com antecedência familiar para diabetes e com a taxa de glicemia alterada. Concluímos que estes sinais sugerem predisposição para Diabetes e que novos estudos são necessários para avaliar a herdabilidade. / The method to identify early the predisposition for Diabetes mellitus should be investigated, since the disease is a public health problem. Scholars of iridology claim that the Sign of Pancreas and the Cross of Andreas suggest predisposition to diabetes. Our objectives were to determine the prevalence of these signals in subjects with and without the disease and its heritability. Data collection occurred between February 2010 and June 2011. Participants 356 individuals older than 30 years treated at the Health Center School. Individuals with diabetes had a higher prevalence of signs studied iridology. The Student t test showed statistically significant differences in the prevalence of these signs between patients with and without diabetes and among individuals with and without family history of the disease. The Chi Square demonstrates that having both signals increase the chance of developing diabetes. The Pearson correlation coefficient shows a correlation between the signals studied with a family history of diabetes and the blood glucose alteration. We conclude that these signs suggest a predisposition to diabetes and that further studies are needed to assess the heritability.

Breast cancer is one of the leading causes of morbidity and mortality among women. A diagnosis of cancer is a stressful event that requires an individual to adapt to new stressors. The purpose of this qualitative study was to better understand the perceptions of mana'olana/hope and living with breast cancer among Native Hawaiian women. The conceptual framework of this phenomenological study was positive psychology. Data collection included in-depth interviews with 5 Native Hawaiian women who had been diagnosed with breast cancer. Data coding and analysis resulted in identification of 8 themes. The themes included: (a) mana'olana /hope is the essence of my being, (b) family strengthens me and gave me mana'olana/hope, (c) my relationship with God and Jesus promoted mana'olana/hope in me, (d) my religious affiliation promoted mana'olana/hope in me, (e) the cancer support group promoted mana'olana/hope in me, (f) the cancer treatment team promoted mana'olana/hope in me, (g) treatment options; Allopathic, Osteopathic, Naturopathic, Alternative medicine, and herbal remedies promoted mana'olana/hope in me, and (h) nature's beauty and the arts promoted mana'olana/hope in me. Results may be used by health psychologists, cancer treatment practitioners, and the field of biobehavioral oncology to support and improve the well-being and health outcomes of women diagnosed with breast cancer.