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Background: Axial spondyloarthritis (AxSpA) is a chronic disease which results in fatigue, pain, and reduced quality of life (QoL). Traditional Chinese medicine (TCM), especially acupuncture, has shown promise in managing pain. Although a TCM collaborative model of care (TCMCMC) has been studied in cancer, there are no randomized controlled trials investigating TCM in AxSpA. Therefore, we will conduct a pragmatic trial to determine the clinical effectiveness, safety, and cost-effectiveness of TCMCMC for patients with AxSpA. We define TCMCMC as standard TCM history taking and physical examination, acupuncture, and TCM non-pharmacological advice and communications with rheumatologists in addition to usual rheumatologic care. The purpose of this paper is to describe the rationale for and methodology of this trial.Methods/design: This pragmatic randomized controlled trial will recruit 160 patients who are diagnosed with AxSpA and have inadequate response to non-steroidal anti-inflammatory drugs (NSAIDs). Simple randomization to usual rheumatologic care or the intervention (TCMCMC) with a 1:1 allocation ratio will be used. Ten 30-min acupuncture sessions will be provided to patients assigned to the TCMCMC arm. All participants will continue to receive usual rheumatologic care. The primary endpoint - spinal pain - will be evaluated at week 6. Secondary endpoints include clinical, quality of life, and economic outcome measures. Patients will be followed up for up to 52 weeks, and adverse events will be documented.Discussion: This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of a TCMCMC for patients with AxSpA.Trial Registration: ClinicalTrials.gov, NCT03420404 . Registered on 14 February 2018. [ABSTRACT FROM AUTHOR]

Background: Acupuncture has become a more popular complementary and alternative medicine worldwide. As pneumothorax is a rare acupuncture-related adverse event (AE), it is thought to be under-recognized by acupuncturists and emergency physicians, and the public is often not aware of this potential AE resulting in delayed hospital presentation. Methods: This is a case series of acupuncture-related pneumothoraces diagnosed in an emergency department (ED) in Singapore. Data was collected retrospectively from patients' notes and prospectively from the patients over the phone. Case presentations: Between 2017 and 2021, 4 out of 474 (0.84%) pneumothoraces were acupuncture related. Three of these patients consented to participate in this study. One patient developed bilateral pneumothoraces. All 3 patients claimed that they were not informed by the acupuncturists of potential serious AEs prior to acupuncture treatments and that they were not aware that such AE could occur. All 3 patients had reported their symptoms of chest pain and/or breathlessness to their acupuncturists post-treatment, but they were not advised to seek urgent medical attention. When the 3 patients had informed their acupuncturists about their diagnosis of pneumothorax, 2 of the acupuncturists did not seem to be aware of this acupuncture-related AE. Discussion: When pneumothorax manifests, there is a potential need for an invasive procedure and continuous monitoring as it may devolve into a life-threatening condition with cardiovascular compromise. Early medical recognition and attention are needed to ensure optimal patient outcomes. In the appropriate population cohort, a history of prior acupuncture treatments should be included as part of history-taking assessment in patients presenting with chest pain and/or breathlessness. Conclusion: Emergency physicians should be vigilant of this potentially serious and life-threatening complication for anyone presenting with chest discomfort and/or breathlessness after recently undergoing acupuncture to ensure earlier diagnosis, management, and better patient outcome. [ABSTRACT FROM AUTHOR]

Globally, illegal and unsustainable wildlife trade can drive biodiversity loss. Understanding which product attributes consumers consider when deciding between products of threatened species or alternatives, is key for conservation interventions. Labeled Discrete Choice Experiments (DCEs) are underutilized in wildlife trade literature but can aid this understanding. In labeled DCEs, the alternatives presented to respondents have specific names (e.g., paracetamol) as opposed to being generic bundles (e.g., option A). We used a labeled DCE to assess young adult preferences toward "cooling water" used to treat fever and heatiness (a traditional Chinese medicine state of illness) in Singapore. One popular cooling water contains saiga horn, made from Critically Endangered Saiga tatarica antelope. Data from 639 university‐enrolled respondents were analyzed using latent class models. Middle‐ to high‐income Chinese Singaporeans were the respondents most likely to choose saiga horn. Overall, however, respondents significantly preferred lower price products sold in nearby outlets—suggesting that for young adults in Singapore, saiga horn cooling water may be substitutable if its physical and financial availability is reduced. [ABSTRACT FROM AUTHOR]

This paper addresses the challenge posed to traditional Chinese medicine by the ethos of science and explores three related assumptions. First, the ethos of traditional Chinese medicine is incompatible with the ethos of science. Second, the challenge of science to traditional Chinese medicine is represented by the requirement to comply with internationally recognized standards of medical research and practice applied to biomedicine, adopted and implemented by the State. The State requires that the safety and effectiveness of traditional Chinese medicine procedures and medications be ascertained following the methodology chartered by the ethos of science. Third, traditional Chinese medicine practitioners present a third ethos, the “ethos of pragmatic healing” based on the pragmatic acculturation of clinical practice, as an alternative to the ethos of science. This third ethos is an inadequate response to the challenge because it increases the divergence between health care policy requirements of scientific scrutiny and the fostering of traditional Chinese medicine as an icon of Chinese culture. The study is based on data from personal interviews with representative samples of three ethnic populations in Singapore; secondary data from other studies; relevant official data; and documents from biomedical and traditional Chinese medicine organizations. The methods include inductive analysis, multiple correlation and regression, and factor analysis among others. The analysis indicates that the pressure to comply with official health regulations and the inability to succeed under the ethos of science lead traditional Chinese medicine practitioners to respond with an ethos of pragmatic healing that eschews conceptual analysis, ignores the paradigmatic divide with biomedicine, and focuses on “using what works”. This third ethos can only be a temporary response to the pressure to upgrade the practice of traditional Chinese medicine and it does not correspond to pragmatic acculturation commonly found in the population. The ethos of pragmatic healing leaves the challenge of science unresolved and it is likely to increase the level of conflict between the realm of biomedicine (including health care policy requirements of scientific scrutiny) and the ethos of traditional Chinese medicine. [Copyright &y& Elsevier]

Interventions to shift the behaviour of consumers using unsustainable wildlife products are key to threatened species conservation. Whether these interventions are effective is largely unknown due to a dearth of detailed evaluations. We previously conducted a country-level online behaviour change intervention targeting consumers of the Critically Endangered saiga antelope (Saiga tatarica) horn in Singapore. To evaluate intervention impact, we carried out in-person consumer surveys with >2,000 individuals pre- and post-intervention (2017 and 2019), and 93 in-person post-intervention surveys with traditional Chinese medicine (TCM) shopkeepers (2019). The proportion of self-reported high-usage saiga horn consumers in the target audience (Chinese Singaporean women aged 35–59) did not change significantly from pre- to post-intervention (24.4% versus 22.6%). However, post-intervention the target audience was significantly more likely than the non-target audience to accurately recall the intervention message and to report a decrease in saiga horn usage (4% versus 1% reported a behaviour change). Within the target audience, high-usage consumers were significantly more likely than lower-usage consumers to recall the message and report a behaviour change. Across respondents who reported a decrease in saiga horn usage, they cited the intervention message as a specific reason for their behaviour change significantly more than other reasons. Additionally, across all respondents, the belief that saiga is a common species in the wild decreased significantly from pre- to post-intervention. TCM shopkeepers, however, cited factors such as price and availability as the strongest influences on saiga horn sales. In sum, the intervention did significantly influence some consumers but the reduction of high-usage consumer frequency was not significant at the population level. We explore reasons for these findings, including competing consumer influences, characteristics of the intervention, and evaluation timing. This work suggests our intervention approach has potential, and exemplifies a multi-pronged in-person evaluation of an online wildlife trade consumer intervention. [ABSTRACT FROM AUTHOR]

Unsustainable wildlife trade is a pervasive issue affecting wildlife globally. To address this issue, a plethora of demand reduction efforts have been carried out. These necessitate consumer research which provides crucial knowledge for designing and evaluating targeted interventions. We implemented a rigorous consumer survey on saiga (Saiga tatarica) horn use in Singapore, where usage is legal and widely sold. Saiga are Critically Endangered antelopes from Central Asia with horns (often marketed as ling yang) used in traditional Chinese medicine (TCM). Few past studies have assessed saiga horn consumers. This work is the most extensive consumer research to date specifically characterising saiga horn consumers and usage. We conducted 2294 in-person surveys on saiga horn use with Chinese Singaporeans, employing neutral questioning approaches. We found 19% of individuals reported saiga horn as a product they choose most often for themselves and/or others when treating fever and/or heatiness (a TCM state of illness), indicating a minimum estimate of high-frequency usage, not including possible low-frequency users. Overall saiga users were most characterised as middle-aged Buddhists and Taoists. However, saiga users were found in a range of demographic groups. Women preferred saiga shavings (the more traditional form), while men preferred saiga cooling water (the more modern form). About 53% of individuals who used saiga horn themselves also bought it for someone else. Buyers for others were most likely to be female middle-aged Buddhists or Taoists. Key motivating reasons for usage were “it works” and “someone recommended it to me.” The top two reported recommenders were family and TCM shopkeepers. Saiga users were more likely than non-saiga users to perceive saiga as a common species in the wild. This research holds significance for interventions targeting saiga horn consumption within Singapore and throughout Asia, by identifying potential target audiences, product types, non-desirable alternatives, and motivations for use. [ABSTRACT FROM AUTHOR]

Information behavior includes activities of active information seeking, passive acquisition of information, and information use. Guided by the Elaboration Likelihood Model, this study explored elderly Singaporean women’s health information behavior to understand how they sought, evaluated, and used health information in everyday lives. Twenty-two in-depth interviews were conducted with elderly Chinese women aged 61 to 79. Qualitative analysis of the interview data yielded three meta-themes: information-seeking patterns, trustworthiness of health information, and peripheral route of decision making. Results revealed that elderly women took both systematic and heuristic approaches to processing information but relied on interpersonal networks to negotiate health choices. [ABSTRACT FROM AUTHOR]

Context. The use of complementary and alternative medicine (CAM), particularly herbal medicine and their derived products, have been increasing. However, sporadic reports of serious adverse effects associated with the use of these products have become a source of concern. Spontaneous adverse event reporting may be used to monitor the safety of these products. Objective. The objectives of this study is to analyze and describe the patterns of adverse events associated with the use of Chinese Proprietary Medicine, other complementary medicine and health supplements (termed CAM products) in the Singapore Pharmacovigilance database from 1998 to 2009 and to highlight areas of safety concerns. Methods. Adverse events associated with CAM products reviewed by the Vigilance Branch of the Health Sciences Authority for the period 1998-2009 were collated and analyzed. The following information was extracted and collated: patient demographics, type and indication of CAM products, system-organ class affected, seriousness of the adverse event, route of administration, hospitalization status, outcome of adverse event, concomitant use of conventional medicine, adulterant testing and profession of the reporter. Results. In the period 1998-2009, 627 cases of adverse events due to CAM products were reported. Most of these 627 cases (80.2%) were found to be serious and most of the patients used CAM products for sexual performance enhancement (291, 46.4%), to relieve pain such as joint and neck pain (36, 5.9%) and for slimming purposes (27, 4.3%). Of the 627 cases, endocrine disorders constituted 22.5% and central nervous system disorders constituted 20.6%. Liver was the main organ involved in the serious cases. Twenty-two fatalities were reported and hepatotoxicity was responsible for the deaths of 10 patients during the study period. Conclusions. In conclusion, 627 adverse event reports associated with CAM products had been successfully analyzed and described. They constituted ∼3.8% of the total number of adverse events reported from 1998 to 2009. Outbreaks of severe hypoglycemia in 2008 and 2009 were associated with the use of adulterated and illegal sexual performance enhancement products. Further work to confirm the hepatotoxicity of implicated CAM products is warranted. Reporting of suspected adverse events is strongly encouraged even if the causality is not confirmed because any signs of clustering will allow rapid regulatory actions to be taken. The analysis of spontaneously reported adverse events is important in monitoring the safety of CAM products and helps in the understanding of the benefits and risks associated with the use of such products. [ABSTRACT FROM AUTHOR]

This study explores Singaporean Chinese clients' beliefs about psychological problems by comparing their beliefs with those of non-clients and professional counsellors. These three samples were asked to indicate the extent to which they would agree with three belief models, the Chinese indigenous model, the Western psychological model, and the other model. It was found that clients and non-clients were more likely than therapists to endorse the indigenous belief model. Amongst the indigenous sub-models, Chinese medicine was the most endorsed across the three samples; and clients and non-clients endorsed Chinese medicine more than therapists did. The indigenous belief model, especially Chinese medicine was endorsed more by Buddhist and Taoist clients than Christian or non-religionist clients; and by clients holding lower educational qualifications. [ABSTRACT FROM AUTHOR]