Transcript Slide 1

“Linking Primary Care with Anthropology and
Ethnobotany: The Significance of the Elliniko
Resource Centre for Indigenous Knowledge (ELLRIK)
for the University of the Mountains in Crete”
Workshop: The Development of the University of the Mountains
in Crete, Greece - June 2, 2010
Prof. Dr. Christos Lionis
Professor of General Practice and Primary
Care
Head of the Clinic of Social and Family
Medicine
School of Medicine, University of Crete
Outline of the presentation
 A short guidance on the influential factors that guided the linkage
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between anthropology and general practice in both education and
research
The significance of the indigenous knowledge system and the role of
LEAD in developing a global network
A focus on research in medicinal plants
A six stages model in developing biosociocultural research
New areas of developing research in general practice/family medicine
The OTC SOCIOMED FP7 programme
Epilogue
Walking through the narrow street of
research in general practice-I
Ομ. Καθ. Μιχάλης
Φιορέτος/1985
1988
1986
http://www.holiday.gr/member/memberphoto.php?PHOTOID=66&TAG_I
D=80&lang=gr
1993
Walking through the narrow street of
research in general practice-II
1988
1993
Prof. L.J. Slkkerveer
Prof. Emeritus Erik Trell
The significance of Indigenous Knowledge
System
ESTABLISHED INDIGENOUS KNOWLEDGE
RESOURCE CENTERS
The five areas of use of herbal medicine
1. Herbal ailments
2. Herbal treatment as a compensation for inadequate
modern therapy
3. Herbs as a complementary to modern medicine
treatment
4. Herbs used for common health problems
5. Application for maternal and child care
(Le Grand and Wondergem, 1990)
Some evidence from the anthropological
studies in primary care in Crete
Several fieldwork training studies were concentrated on
the use of medicinal plants in Crete. They documented:
An indigenous Knowledge Medical System exists
Identified several Cretan herbs used as seasoning or
infusion for different health and healing purposed
(N. van Beelen 1990, C. van der Hoeven 1992, R. van de Kerk 1993)
Antioxidant effects of herbs in Crete
The antioxidant effect on extracts of ten herbs collected in Crete
was studied
The ability of extracts to inhibit lipid peroxidation was assayed in
human bronchiole cells
Herb extracts decrease lipid peroxidation in cultured lung cells
exposed to iron or ozone
Lipid peroxidation in cells pretreated with a a-tocopherol and then
exposed to iron or ozone was almost similar to the decrease
observed in cells pretreated with Coridothymus capitatus, Salvia
fruticosa and mentha spicata.
(Lionis C, Faresjo A, Skoula M, et al. Lancet 1998)
Translating knowledge
from Medical
anthropology into
research in
General practice:
An example of an
effective collaboration
among social scientists,
rural practitioners and
basic sciences
Antioxidant effects of herbs in Crete
Origanum dictamnus (wild)
Origanum dictamnus (cultivated)
Matricaria recutita
Satyreja thymbra
Coridothymus capitatus
Mentha pulegium
Salvia pomifera
Salvia fruticosa
Origanum marjorana
Mentha spicata
The use of local herbs in the traditional Cretan diet:
its effect on dyspepsia-I
Both
methods.
qualitative
and
quantitative
101 patients were interviewed.
A household survey (35 subjects were interviewed).
(Maaike F Palstra, Doctoral thesis, 2003)
The use of local herbs in the traditional Cretan diet:
its effect on dyspepsia-II
Dyspepsia was found a frequent health problem (52.5% out
of the patients and 60% out of those in the household survey)
17 respondents in the household survey believe that Cretan
herbs have a therapeutic effect and 16 out of them drink a
hot herbal tea
(Maaike F Palstra, Doctoral thesis, 2003)
Fieldwork training reports and PhD Studies
A six stages model for the biosociocultural research in primary care
I.
Making the observations
II. Setting the research idea or question
III. Literature review
IV. Formulating a hypothesis
V. Looking for anthropological evidence
VI. Testing the biological effect (laboratory or animal
models)
(Lionis and Slikkerveer, continuous discussion)
Back to Dioscorides period: Traces of Ancient
Greek Medicine in the practices of a Folk-Healer-I
• Interviewing the lasit surviving bone-setter in the
province of Agios Vassilios, rural Crete
•Basic competencies were fracture restoration and
medicinal preparation for curing several diseases
•Roots cutting techniques
•Use of roots of Arum Maculatum, Cynodon Dactylon,
Dittricia Viscosa, Junctus Acutus, Nerium Oleander,
Osyris Alba were reported.
(Lionis C, 1998)
Back to Dioscorides period: Traces of Ancient Greek
Medicine in the practices of a Folk-Healer-II
• All these plants used by the modern bone-setter in Agios
Vassilios district exist in Dioscorides work.
•We recognise the same name that the local people use in
their dialect as the same therapeutic indications and the
same use.
•It remains to be seen, if the ethoparmacological approach
could be contributory to the new drug development in the
near future.
Sense of control and spirituality in rural
Crete
 Πληθυσμός 2 κοινοτήτων της Επαρχίας Βιάννου
 The Royal Free Interview for Religious and Spiritual Beliefs
(18 items)
(King, et al. Psychol Med 1995)
(Sapountzi-Krepia D)
 The SOC Questionnaire (29 items)
(Καράλης, και συν. Αρχεία Ελληνικής Ιατρικής 2004)
Δ. Παπαζήση 2007. Μεταπτυχιακή Εργασία, Πρόγραμμα Μεταπτυχιακών Σπουδών-Δημόσια Υγεία και
Διοίκηση Υπηρεσιών Υγείας
Measuring the sense of control in rural Crete
(κλίμακα αίσθησης συνεκτικότητας)
A general
salutogenetic theory
”Sense of coherence”
What creates health and search for
"the origin of health" rather
than to look for the causes of
disease.
Three components in the
theory:
Comprehensibility
Meaningfulness
Manageability
religious score Based on q3, q7, q11
SCATTERPLOT = SOC Scale Total with Religious
Scale
30
25
20
15
10
100
120
140
160
TOTAL SOC SCORE
180
200
Η διασύνδεση υπηρεσιών ΠΦΥ και ψυχικής υγείαςθέματα προς συζήτηση
 Ο ρόλος του ιατρού γενικής
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ιατρικής και των υπηρεσιών των
κέντρων υγείας
Ο ρόλος της κοινοτικής
νοσηλεύτριας
Οι κοινοτικές δομές και οι
υπηρεσίες τους
Η διασύνδεση με τις υπηρεσίες των
δήμων και των μη κυβερνητικών
οργανισμών
Η ανάπτυξη δικτύων και η
ολοκλήρωση (integration) του
συστήματος
To νομοθετικό πλαίσιο και η
χρηματοδότηση του
OTC SOCIOMED
“Assessing The Over-The-Counter Medications In Primary Care And
Translating The Theory Of Planned Behaviour Into Interventions”
HEALTH-F2-2009-223654
SEVENTH FRAMEWORK PROGRAMME
Participants Of
OTC SOCIOMED
Project Objectives
 To create scientific partnerships and develop a practice-based network through
research collaboration in order to exchange experiences and make comparisons on
public health care issues, such as prescribing and use of medicines;
 To explore beliefs and attitudes, subjective norms and behavioural control
perception in predicting intention to prescribe medicines;
 To explore determinants of patients’ health behaviour regarding prescription of
medicines and their rational use;
 To develop and implement policy and practice recommendations that will enhance
and improve health care systems;
 To promote research, especially on the development of national monitoring
systems and sustainable nationwide interventions, and on the promotion of
rational medicine use at all levels in the health sector. The recommendations of
EMEA, on how to administer and use certain medicines for compassionate use,
play a significant role in forming the basis of our proposal (EMEA, 2006).
Theoretical Framework
“Mental models are deeply ingrained
assumptions, generalizations, or even pictures
or images that influence how we understand the
world and how we take action”
• Multivariate model of Tran cultural Health Care Utilisation (Slikkerveer, 1990)
•Theory of Planned Behavior (TPB) (Ajzen, 1991)
Epilogue
 The need to revisit the establishment of ELRIK as an
component of the University of Mountains in Crete
 A prompt discussion in investing in additional
research on ethno botany
 A clear need to look for funds in building capacity to
implement biomedical research based on the existing
IMK in Crete