<p>This dissertation presents the results of ethnographic research conducted between September 2006 -August 2007 at Emeritus University; a large, multidisciplinary institution of natural medicine in the United States. Since its inception in 1978, Emeritus University has emphasized an integrated model of medicine and collaboration between practitioners of natural medicine and their allopathic counterparts. By focusing upon curriculum change and the process of learning among first year students in the Master of Science in Acupuncture and Oriental Medicine (AOM) program, I explore the ways in which increasing emphasis upon integration with biomedical models of education, practice, and research influences the AOM curriculum, the professional values inculcated within first year AOM students, and their sense of professional identity and position within the US medical landscape. In addition, this research elucidates how the interests, goals, and decisions of first year students shape and influence the curriculum and the identity of AOM. My research was informed by critical medical anthropology, which situates schools of medical education, and the experiences of individual students, within the historical and political structures of medical pluralism, state regulation, professionalization, biomedical dominance, and the capitalistic world system.</p> <p>This research contributes to our knowledge of the evolution of a complementary/alternative medicine (CAM) modality within the US, the roles played by a school of CAM in the transformation of AOM's identity; the socialization of students and the process of learning; the role of agency; and the implications of integration for the identity of AOM, its practitioners, and health care in the United States. Emeritus University's emphasis upon integration has resulted in an increasingly standardized and biomedically based curriculum. While participants perceived such changes to be part of the 'Americanization' of AOM, from the perspective of critical medical anthropology, integration has serious implications for the identity of AOM and its practitioners. Far from advancing the critique of Biomedicine and the medical system embodied by the holistic and alternative health movements of the 1960's and 70's, Emeritus University may serve to replicate the hegemony of Biomedicine, underscore the primacy of its practitioners, and pave the way towards co-optation of acupuncture and Oriental medicine in the United States.</p> / Thesis / Doctor of Philosophy (PhD)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Inicialmente, este trabalho tece algumas considerações a respeito de apontamentos conceituais teórico-práticos da Homeopatia e fala da construção social da demanda para tal prática, tendo em vista responder ao mal estar difuso que inquieta nossos usuários. A realização de estudos como este que busquem compreender as terapêuticas que incluem as práticas integrativas e complementares no SUS, tal com a Homeopatia, a partir do entendimento sobre sua utilização tanto pelos praticantes como pelos usuários pode contribuir para a pesquisa social sobre essas práticas, visando sua efetiva institucionalização no sistema público de saúde no país. O objetivo deste trabalho foi buscar compreender qual o entendimento de pacientes e de médicos sobre a resposta ao tratamento homeopático, a partir de suas narrativas, visando identificar a existência de relação com os sentidos da integralidade do cuidado. Trata-se de uma pesquisa avaliativa de natureza qualitativa, adotando como informantes-chaves o paciente e o profissional homeopata, e utilizando o prontuário como fonte de informação secundária, com a finalidade de complementar as informações. Como campo de investigação, foram escolhidos três tipos de atendimentos distintos: dois tipos de atendimento realizados em serviços públicos, onde o profissional realiza abordagem exclusivamente homeopática (nos municípios de Juiz de fora e do Rio de Janeiro) e um no PSF de Volta Redonda, no qual o atendimento homeopático está incluído nas atividades do médico de família. Foram realizadas também entrevistas cujas análises foram ordenadas (com relação às narrativas dos entrevistados) em diversas disposições para possibilitar diferentes cortes de análises. Os resultados apresentados são discutidos relacionando-os com as categorias representativas da Integralidade que mais se fizeram presentes, a saber, a Integralidade na dimensão da abordagem total do paciente, a autonomia e o cuidado. Essas categorias nos levam a pensar na possibilidade de apresentarem-se como campos possíveis de serem incluídos em fichas clínicas nas quais o profissional, juntamente com o paciente, seriam convidados a refletir, a cada etapa do tratamento, e a sinalizar em que direção a resposta terapêutica está se dando, registrando suas observações de forma objetiva e contribuindo, desta forma, para a análise e a avaliação da integralidade no tratamento homeopático. As conclusões deste trabalho contribuem no sentido de ampliar as possibilidades de avaliação, dando visibilidade à dimensão integral do tratamento homeopático com todo o seu leque semântico e dialógico evidenciados neste estudo, bem como de proporcionar avanços no processo de institucionalização no sistema público de atendimento à saúde, pois a avaliação enquanto etapa final desse processo ocorre ao se medir seus resultados e conferir-lhe validação. Tal atitude ainda possibilita, ao binômio médico-paciente, uma oportunidade de crítica e de avaliação permanente sobre o processo terapêutico que se está experimentando. / This work makes considerations about Homoeopathy, emphasizing some of its theoretical and practical concepts and the social construction of the claim that performs it, viewing to answer some doubts for its anxious users. The initiative of this study is justified by the increasing necessity in understanding better some integrative and complementary practices of SUS like Homoeopathy having a new perspective of view: the comprehension of their utilization by both assistants and patients, contributing with the social research of them, aiming at their institutionalization in Brazils Public Health System. Trying to comprehend the understanding of physicians and users about the results of Homoeopathic treatment was the goal of this work, considering, then, their speeches, tempting to identify a possible correlation of them with the ideas of integrality of care. It is a evaluative, qualitative research, adopting the patients and the homoeopaths as key-informers, having the handbooks of the first ones as a source of secondary additional information. There were chosen three kinds of attendances: two of them in public exclusive homeopathic services (in Juiz de Fora MG e Rio de Janeiro RJ) and the other in PSF in Volta Redonda RJ. The discussion of the interviews (ordered based on different collected speeches) was analyzed, relating them with the most representative categories of integrality found: the total approach of the patient, the autonomy and the care. With this, a perspective of having them included in clinical questionnaires could be possible, inviting the professionals to reflect (close to the patients) each step of the treatment and its course, registering objective observations, contributing with the analysis and evaluation of the integrality in homeopathic treatment. The conclusions contribute in not only amplify the possibilities of homoeopathic evaluation considering the topic integrality, but in affording some advances in the process of its institutionalization in the public healthy system too, giving validation to it. Besides, the binomial doctor-patient is until considered, suggesting a constant reflection about the efficacy of the therapeutic process.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Inicialmente, este trabalho tece algumas considerações a respeito de apontamentos conceituais teórico-práticos da Homeopatia e fala da construção social da demanda para tal prática, tendo em vista responder ao mal estar difuso que inquieta nossos usuários. A realização de estudos como este que busquem compreender as terapêuticas que incluem as práticas integrativas e complementares no SUS, tal com a Homeopatia, a partir do entendimento sobre sua utilização tanto pelos praticantes como pelos usuários pode contribuir para a pesquisa social sobre essas práticas, visando sua efetiva institucionalização no sistema público de saúde no país. O objetivo deste trabalho foi buscar compreender qual o entendimento de pacientes e de médicos sobre a resposta ao tratamento homeopático, a partir de suas narrativas, visando identificar a existência de relação com os sentidos da integralidade do cuidado. Trata-se de uma pesquisa avaliativa de natureza qualitativa, adotando como informantes-chaves o paciente e o profissional homeopata, e utilizando o prontuário como fonte de informação secundária, com a finalidade de complementar as informações. Como campo de investigação, foram escolhidos três tipos de atendimentos distintos: dois tipos de atendimento realizados em serviços públicos, onde o profissional realiza abordagem exclusivamente homeopática (nos municípios de Juiz de fora e do Rio de Janeiro) e um no PSF de Volta Redonda, no qual o atendimento homeopático está incluído nas atividades do médico de família. Foram realizadas também entrevistas cujas análises foram ordenadas (com relação às narrativas dos entrevistados) em diversas disposições para possibilitar diferentes cortes de análises. Os resultados apresentados são discutidos relacionando-os com as categorias representativas da Integralidade que mais se fizeram presentes, a saber, a Integralidade na dimensão da abordagem total do paciente, a autonomia e o cuidado. Essas categorias nos levam a pensar na possibilidade de apresentarem-se como campos possíveis de serem incluídos em fichas clínicas nas quais o profissional, juntamente com o paciente, seriam convidados a refletir, a cada etapa do tratamento, e a sinalizar em que direção a resposta terapêutica está se dando, registrando suas observações de forma objetiva e contribuindo, desta forma, para a análise e a avaliação da integralidade no tratamento homeopático. As conclusões deste trabalho contribuem no sentido de ampliar as possibilidades de avaliação, dando visibilidade à dimensão integral do tratamento homeopático com todo o seu leque semântico e dialógico evidenciados neste estudo, bem como de proporcionar avanços no processo de institucionalização no sistema público de atendimento à saúde, pois a avaliação enquanto etapa final desse processo ocorre ao se medir seus resultados e conferir-lhe validação. Tal atitude ainda possibilita, ao binômio médico-paciente, uma oportunidade de crítica e de avaliação permanente sobre o processo terapêutico que se está experimentando. / This work makes considerations about Homoeopathy, emphasizing some of its theoretical and practical concepts and the social construction of the claim that performs it, viewing to answer some doubts for its anxious users. The initiative of this study is justified by the increasing necessity in understanding better some integrative and complementary practices of SUS like Homoeopathy having a new perspective of view: the comprehension of their utilization by both assistants and patients, contributing with the social research of them, aiming at their institutionalization in Brazils Public Health System. Trying to comprehend the understanding of physicians and users about the results of Homoeopathic treatment was the goal of this work, considering, then, their speeches, tempting to identify a possible correlation of them with the ideas of integrality of care. It is a evaluative, qualitative research, adopting the patients and the homoeopaths as key-informers, having the handbooks of the first ones as a source of secondary additional information. There were chosen three kinds of attendances: two of them in public exclusive homeopathic services (in Juiz de Fora MG e Rio de Janeiro RJ) and the other in PSF in Volta Redonda RJ. The discussion of the interviews (ordered based on different collected speeches) was analyzed, relating them with the most representative categories of integrality found: the total approach of the patient, the autonomy and the care. With this, a perspective of having them included in clinical questionnaires could be possible, inviting the professionals to reflect (close to the patients) each step of the treatment and its course, registering objective observations, contributing with the analysis and evaluation of the integrality in homeopathic treatment. The conclusions contribute in not only amplify the possibilities of homoeopathic evaluation considering the topic integrality, but in affording some advances in the process of its institutionalization in the public healthy system too, giving validation to it. Besides, the binomial doctor-patient is until considered, suggesting a constant reflection about the efficacy of the therapeutic process.

Magister Curationis - MCur / In this minithesis a systematic review of all of the available contemporary literature on post-breast cancer lymphoedema was undertaken. The purpose of this systematic review was to search for, collate, synthesize and thereby provide the reader with a comprehensive, evidence-based account of all the available research published between 1988 and 2008 on the treatment of post-breast cancer lymphoedema with natural medicine.Because the large number of articles published every year across a plethora of biomedical journals makes it incredibly difficult for practitioners to keep up-to-date within their specialized areas, systematic reviews are particularly useful as they summarize high quality, contemporary scientific knowledge on a topic in one place (Antman, Lau, Kupelnik, Mosteller & Chalmers, 1992). One such topic on which many health practitioners have a paucity of information regarding management and risk reduction is lymphoedema (Radina, Armer, Culbertson & Dusold,2004) The primary objective of this research project was to assess the effects of natural medicine on post-breast cancer lymphoedema in regard to 1) life style improvement including any signs and symptoms related to the condition such as heaviness, tightness, pain, ache, itch, mobility of the affected arm, skin texture as well as psychological symptoms like distress;2) arm volume changes of the affected limb; 3) adverse effects; and 4) modification or cessation of treatment.Several online databases were searched for articles that contain the term lymphoedema, lymphedema, limb swelling or "linfedema" (Spanish and Portuguese); thereby including all possible spellings in English, Spanish and Portuguese. Relevant information was extracted and recorded in tabular format. The quality of each study was analysed using a checklist,which was drawn up by the primary researcher and study supervisor based on the CONSORT guidelines (Altman, 1996).To ensure quality, only randomized controlled trials, quasi-randomized controlled trials or clinical trials that met the inclusion or exclusion criteria, reporting benefits or adverse effects of natural medicines for the treatment of post-breast cancer lymphoedema were included. In addition,studies had to focus on natural medicine versus placebo or routine treatment or no treatment as types of intervention; and participants had to include women of all ages that had been diagnosed with post-breast cancer lymphoedema.The relevant data from included studies was entered into Review Manager 5 (Revman 5) software for meta-analysis. The primary studies included in this systematic review generally suffered from small sample sizes, varied somewhat in their operationalisation of outcomes and the format for presenting results, making meta-analysis very difficult. However, results suggest that sodium selenite taken orally and CYCLO 3 FORT also taken orally are effective in the reduction of limb volume. The results also suggested that aromatherapy using an intervention cream containing wheat germ oil and essential oils of fennel, sage, geranium, black pepper and juniper; and vitamin E plus pentoxifylline taken orally are not effective.Seeing as these results are drawn from single studies with heterogeneous outcome variables, they should be seen as tentative until they are confirmed by replication. Gaps in the literature regarding natural medicine as a treatment for post-breast cancer lymphoedema were identified, and recommendations for further research are proposed.

In this Master's of Public Issues Anthropology thesis I examine the perceptions of health and healthcare services within a small rural subsistence farming community in South-Western Paraguay from a political ecology of health perspective. Qualitative research data was collected from May to September of 2010 in Lindo Manantial, a subsistence farming village, and Piribebuy, the closest town to Lindo Manantial and the location of the nearest health centre, the Piribebuy Centro de Salud. The primary goals of this research project were to gain an ethnographic understanding of current local health perspectives and concerns, as well as the local frameworks for health provision in Piribebuy. I argue that the introduction of culturally competent healthcare services could greatly improve individual and community health statuses and outcomes in Lindo Manantial and other similar rural subsistence farming communities in Paraguay. / Social Sciences and Humanities Research Council of Canada (SSHRC)

This doctoral thesis discusses the manifestations of animism among Khmers in Cambodia and in south Vietnam. The subject is viewed from the culturally-anthropological perspective and attention is paid primarily to the specifics that are present in the everyday life of Khmers. The paper characterizes the manifestations of animism within the scope of the selected hypotheses and perceives this topic through various ethnological paradigms. The doctoral thesis marginally introduces animism as a phenomenon, the Khmer as a people, animistic rituals, and traditional Khmer feasts. Furthermore, the paper focuses on the importance of the shaman and other spiritual figures in the Khmer religious conception, the topic of healing, rites of passage, specific Khmer supernatural entities, and places where they are worshipped. The entire thesis includes the comparison of theoretical knowledge with the results of empirical research in selected areas. Using specific examples, it is demonstrated that animism is a part of syncretism, which is still an important component of the Khmer culture and significantly influences important life decisions. Rather than a unified discourse that would strictly subscribe to linear composition, the doctoral thesis is a prolegomenon to the phenomenon of animism in the Khmer culture and...