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The paper analyses the experiences with government sanctioned Ayurvedic college education of 14 young Ayurvedic doctors working at the Integrative Health Centre in Bangalore, India. Unfamiliarity with Ayurvedic logic and Indian natural philosophies, lack of clinical training and the mixing-up of Ayurvedic and biomedical notions are their main complaints. The 14 young Ayurvedic doctors also missed a convincing perspective on how to integrate Ayurvedic logic, modern scientific knowledge and biomedical diagnostics. Ayurvedic state sanctioned education seems to be caught between Ayurveda's natural philosophy of health and the techno-science of biomedicine. The Ayurvedic doctors under scrutiny face the danger of becoming ‘half-baked products’ when they do not learn to reflect on the tension between Indian traditional knowledge and biomedical learning. The paper argues that the logic of modern science and biomedicine's claim to value-free knowledge captivates Ayurvedic education and research. This hinders Ayurveda's development as a vibrant alterity to biomedicine. What is needed is a critical social science perspective on the construction of medical knowledge and India's hierarchical medical landscape. [ABSTRACT FROM AUTHOR]

Traditional healing systems are indigenously rooted arrangements of social relationships, cultural patterns and therapeutic activities involving use of locally available or adopted resources which are used in the management of illness. All of the 705 scheduled tribes of India have their own distinct healing systems catering to natural and supernatural caused illnesses. The paper tries to look at and understand the ethnomedical systems of the Indian scheduled tribes by identifying common characteristics, healers and efficacy. Such healing systems needed to be seen as alternative forms of knowledge and medicinal practices having strong bearing for amelioration of the health care needs of the scheduled tribe communities as well as the larger humanity. [ABSTRACT FROM AUTHOR]

Psychotherapeutic practices in India observes a paradigm shift with the current focus on the indigenous movement which has hit the discipline of Psychology like any other stream in Social Sciences and Humanities. The professional challenges and issues faced by the mental health professionals in this country has always revolved around on the 'uncanny' realm of myths, beliefs and religions as far as mental illness is concerned (Prasadarao & Sudhir, 2001). Efforts have been initiated in exploring the cultural and social roots of the health-illness constructs as well as debating on the possibility of 'integration' of these different philosophies. This paper is designed to understand the various therapeutic forms and processes in indigenous healing practices and to analyse the negotiation between indigenous healing practices and psychotherapy with special reference to Karnataka, one of the States situated in the Southern part of India. The study approaches the cultural landscape of Karnataka state based on a qualitative research design wherein in-depth unstructured interview of healers and mental health practitioners and systematic observation of some indigenous healing forms are adopted as methods of data collection. The paper concludes by looking at the challenges of constructing ethnospecific interventions in psychotherapy and the need to develop more cultural-specific theories taking into account the cultural history of the community. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: Inspite of tremendous advances made in allopathic medical practices, herbs still play an important role in the management of various liver diseases. A large number of plants and formulations have been claimed to have hepatoprotective activity. Jaundice is a symptom, indicative of the malfunctioning of the liver. This paper provides ethnomedicinal information on the plants used to treat jaundice by three important indigenous communities, i.e., nomadic Gujjars, Tharu and Bhoxa of Sub-Himalayan region, Uttarakhand, India. Aims of the study: To record herbal preparations used by the studied indigenous communities in treatment of jaundice and discuss hepatoprotective properties of the recorded plants. Research strategy and methods: The traditional knowledge of the studied indigenous communities on herbal preparations used for treating jaundice was collected through structured questionnaire and personal interviews. The interviews were conducted with 91 traditional healers (29 Bhoxa, 35 Tharu and 27 nomadic Gujjars) in Sub-Himalayan region of Uttarakhand, India. More than 250 research papers reporting ethnomedicinal information on the hepatoprotective plants used by various communities from different parts of India were extensively reviewed. Results: A total of 40 medicinal plants belonging to 31 families and 38 genera were recorded to be used by the studied communities in 45 formulations as a remedy of jaundice. Bhoxa, nomadic Gujjars and Tharu communities used 15, 23 and 9 plants, respectively. To our knowledge eight plants reported in the present survey viz., Amaranthus spinosus L., Cissampelos pareira L., Ehretia laevis Roxb., Holarrhena pubescens Wall., Ocimum americanum L., Physalis divaricata D. Don, Solanum incanum L. and Trichosanthes cucumerina L. have not been reported earlier as remedy of jaundice in India. Literature review revealed that a total of 214 (belonging to 181 genus and 78 families), 19 (belonging to 18 genus and 12 families) and 14 (belonging to 14 genus and 11 families) plant species are used as internal, external and magico-religious remedies for jaundice, respectively by various communities in different parts of India. Most widely used hepatoprotective plant species for treatment of jaundice in India is Boerhavia diffusa L. followed by Tinospora cordifolia (Willd.) Miers, Saccharum officinarum L., Phyllanthus amarus Schumach. & Thonn., Ricinus communis L., Andrographis paniculata (Burm. f.) Nees., Oroxylum indicum (L.) Kurz, Lawsonia inermis L. and Eclipta prostrata (L.) L. Conclusions: The plants recorded in the present survey have also been discussed in relation to pharmacological studies and hepatoprotective phytoconstituents present in them. Most of the recorded plants have shown hepatoprotective effects on experimental animals in earlier studies but more studies are needed to assess hepatoprotective properties of some recorded medicinal plants viz., Averrhoa carambola L., Ehretia laevis Roxb., Holarrhena pubescens Wall., Mangifera indica L., Ocimum americanum L., Oroxylum indicum (L.) Kurz, Physalis divaricata D. Don, Solanum incanum L., Sphaeranthus senegalensis DC. and Tribulus terrestris L.. The plants enumerated in this study with high number of citations and wider distributions have given some useful leads for further biomedical research. Nevertheless more phytochemical, pharmaceutical and clinical studies are needed to evaluate hepatoprotective properties, efficacy and safety of all the claimed medicinal plants. [Copyright &y& Elsevier]

The co-existence of different types of medical systems (medical pluralism) is a typical feature of India's healthcare system. For conditions such as influenza-like illness (ILI), where non-specific disease signs/symptoms exist, clinical reasoning in the context of medical pluralism becomes crucial. Recognising this need, we undertook a qualitative study, which explored factors underpinning clinical decisions on diagnosis and management of ILI. The study involved semi-structured interviews including clinical vignettes with 20 healthcare practitioners (working within allopathy, homeopathy and Ayurveda) working in the private healthcare sector in Solapur city, India. An inquiry was conducted into criteria influencing the diagnosis, treatment, referral to specialist care and role of treatment guidelines for ILI. Thematic analysis was used to identify aspects relating to ILI diagnosis, treatment and referral. The diagnosis of influenza was based largely on clinical symptoms suggestive of influenza in the absence of other diagnoses. Referral for laboratory tests was only initiated if illness did not resolve, generally after 2–3 consultations. Antibiotics were often prescribed for persistent illness, with antivirals rarely considered. Some differences between practitioners from different medical systems were observed in relation to treatment and referral in case of persistent illness. A combination of analytical and intuitive clinical reasoning was used by the participants and clinical decisions were based on both social and clinical factors. Clinical decision-making was rarely a linear process and respondents felt that broad guidelines on influenza that allowed doctors to account for the sociocultural context within which they practised medicine would be helpful. [ABSTRACT FROM AUTHOR]

India ranks first in milk production in the world. Government of India plans to increase the milk production at the rate of 23% per year. The various cost effective and practically feasible strategies which can be implemented for increasing milk production in India especially Kerala, are reviewed in this paper with emphasis on technologies such as unconventional and complete feed. The problems and solutions in Iced and fodder sector in India are reviewed separately. Several general recommendations, which can be practically implemented in the field for the betterment of the sector in India especially Kerala, arc also discussed. [ABSTRACT FROM AUTHOR]

Objectives: This study explored the subjective accounts of the main barriers to self-monitoring of blood-glucose (SMBG) and medication-management among Indian patients with type 2 diabetes (T2DM), their primary family-members (PFMs) and physicians. Methods: Using convenience sampling, patients with T2DM, their PFMs, and physicians, residing in a South Indian capital city, were recruited for semi-structured, audio-recorded interviews. Thematic analysis was used to analyze the data. Results: Fifty patients (female = 14; mean age = 42.5 years) and their PFMs (female = 38; mean age = 39 years), and 25 physicians (female = 4; mean age = 49.8 years) were recruited. Three superordinate themes were identified: (i) complex medication-regimen: confusion, forgetting and reduced motivation, (ii) family recommendations of alternative therapies due to the social pressures of avoiding stigma, intrusiveness and being misrepresented for injecting insulin, and (iii) an expensive illness: choosing to spend money on only medication. Discussion: Implications of the findings highlight the need to (i) train physicians in communication and empathy skills, (ii) empower patients to communicate their barriers to physicians through triadic communication models and question-prompt lists, (iii) educate communities on the benefits of insulin for managing T2DM to reduce stigma, and (iv) equip communities with information about health insurance to address the financial toll of T2DM management. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance Being one of the most common types of life threatening diseases in Southern Assam, India, the digestive system disorders (DSD) have gained much attention in recent decades. Traditional beliefs and inadequate income of mass population result in the use of alternative phytotherapies to treat the diseases. Aim of the study The present paper documents the medicinal knowledge and utilization of plants for treatment of digestive system disorders in Southern Assam, India by Disease Consensus Index (DCI). It also determines the most suitable plant species used to treat digestive system disorders in the study area. Materials and methods The study was based on ethnomedicinal field survey covering a period of 1 year from 2014–2015. The ethnomedicinal information was collected by using semi-structured questionnaires from different traditional Bengali people having knowledge on medicinal plants. Collected data were analyzed by calculating DCI. Results During the survey, 29 informants were interviewed and a total of 49 plants under 46 genera belonging to 33 families were listed. Data analysis revealed that Litsea glutinosa , Momordica charantia , Andrographis paniculata , Lawsonia inermis , Cleome viscosa , Psidium guajava , Ageratum conyzoides , Cuscuta reflexa , Cynodon dactylon and Carica papaya are the most prominent plants among the people of Southern Assam for treating DSD. Conclusion This explorative survey emphasizes the need to preserve and document the traditional healing practices for managing DSD inviting for more imminent scientific research on the plants to determine their efficacy as well as safety. With the help of statistical analysis (DCI), we propose 10 priority plants for DSD in present work. Systematic pharmacological study with these plants may contribute significant result. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to determine the prevalence and correlates of health care responsiveness by conventional, traditional and complementary medicine providers in middle-aged and older community-dwelling adults from the India Longitudinal Ageing Study in India (LASI) Wave 1 in 2017– 2018. Methods: The cross-sectional sample included 37,852 participants who received outpatient health care in the past 12 months, of which 33,615 had visited a conventional health facility, 2120 an AYUSH facility, and 2117 a traditional health practitioner (THP). Results: The prevalence of poor health care responsiveness was 10.1% overall, and 10.7% for the conventional health facility, 8.3% for AYUSH, and 5.7% for the THP. In adjusted logistic regression analysis using the whole sample, the prevalence of poor health care responsiveness was significantly lower among AYUSH and THP clients than among conventional health care clients. Having higher education, higher socioeconomic status and being a Sikh decreased the odds of poor health care responsiveness, while being a member of a caste, having two or more chronic diseases, functional disability, and visiting the health facility for immunisation increased the odds of poor health care responsiveness. In regard to the AYUSH provider, older age decreased the odds and member of a caste, being a Christian and functional disability increased the odds of poor health care responsiveness, and in terms of the THP, being a Sikh decreased the odds and older age, functional disability and visiting the THP for immunisation and for treatment for injury/accident increased the odds of poor health care responsiveness. Discussion: One in ten middle-aged or older adults in India reported poor health care responsiveness, and several sociodemographic and health factors were identified associated with poor health care responsiveness by different service providers. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: India has a population with high degree of medical pluralism. Siddha system of Indian traditional medicine is practiced dominantly by the people in Tamil Nadu. The traditionally trained Siddha healers still play an important role in the rural health care. Their knowledge is comparatively more vulnerable than the documented traditional knowledge. Thus, the present study was aimed to document and quantitatively analyze the local knowledge of the traditional Siddha healers in Virudhunagar district of Tamil Nadu, India. Materials and methods: The results presented in this paper are the outcome of series of interviews conducted between January and August, 2010 consisting of 196 field days. After getting prior informed consent, interviews were conducted and successive free-listing was used in the interviews in order to make informants cite the medicinal plants that they have used. By this way 96 healers were interviewed and their data were quantitatively analyzed using various indices such as Informant Consensus Factor (F ic), Fidelity Level (FL), Informant Agreement on Remedies (IAR) and Cultural Importance Index (CII). Results: This study recorded the ethno-medicinal usage of 227 species which were used to prepare 611 formulations for the treatment of 36 illness categories. The knowledge holders had the experience of minimum 20 years. There was unevenness in male–female ratio. Regarding the medicinal plants, easily available plants were holding significantly high number of citations, IAR and CII values. Nine illness categories had a high F ic value, compared to others. Species with high citations in these groups were Moringa oleifera (aphrodisiacs), Acalypha indica (dermatological ailments), Dodonaea viscosa (musculo-skeletal disorders), Solanum trilobatum (pulmonary ailments), Phyllanthus amarus (jaundice), Piper nigrum (adjuvant) Allium cepa (hemorrhoids), Azadirachta indica (antiseptic) and Tribulus terrestris (urinary ailments). Conclusion: Quantitative analysis of the data had revealed that the easily available species hold a high consensus and cultural importance. Future biomedical studies using the medicinal plants enumerated in this study, particularly those with high number of citations and high F ic values might yield some novel prototypes. Such studies will also be useful to assess the efficacy and safety of these herbal treatments to take decisions on the health care of rural India. [Copyright &y& Elsevier]

Hierarchies of power among healthcare professionals are well documented, nonetheless, power remains neglected, understudied and under-theorised in health systems analysis and policy discussions, especially in the domain of Traditional, Complementary and Alternative Medicine (TCAM). Sociological and public health scholarship has documented the persistence of medical dominance in the health system, theorised as the limitation, subordination, exclusion and incorporation of other professions. This paper explores how interprofessional power dynamics shape the integration of TCAM into Indian primary healthcare centres, as part of a nationwide policy of TCAM integration and medical pluralism implemented since 2005. We conducted interviews (n = 37) with health system administrators, nurses, pharmacists, TCAM and biomedicine doctors, and observed day-to-day activities of primary healthcare centres for six months in Odisha state, India. Thematic analysis enabled the identification of themes and exploration of sub-themes. The analysis revealed multilayered forms of medical dominance within the primary healthcare system and identified multiple sites where everyday power is mobilised. Biomedicine practitioners exercised authoritative power and restricted TCAM doctors' access to facility-level resources, i.e. financial and workforce support, which inhibited the integration policy implementation. Significantly, TCAM doctors were 'ordered' to practice biomedicine at primary healthcare centres, which was beyond the scope of the integration policy. However, TCAM doctors were also able to exercise countervailing power in their day-to-day activities in the primary healthcare centres and sought to assist patients' health behaviour change through their authoritative knowledge about 'how to live a healthy life'. The health system actors involved in policy implementation hold a range of forms of power specific to the circumstances, influencing the integration processes. We explain these dynamics in relation to existing theories of medical dominance and countervailing power, while introducing a previously unreported dimension of dominance: 'co-optation', which enrols TCAM practitioners in the practice of biomedicine. • Medical dominance in Indian primary health care centres (PHCs) is multi-layered. • AYUSH doctors working in PHCs experience subordination, exclusion and limitation. • A new form of medical dominance – co-optation – was also uncovered in this setting. • Co-optation here involved AYUSH doctors being ordered to undertake biomedical tasks. • Via countervailing power, AYUSH doctors retained autonomy in community-based work. [ABSTRACT FROM AUTHOR]

Background Adverse drug reactions (ADRs) monitoring in cancer patients is important to ensure early detection, effective management and possible prevention subsequently. Objectives This study was conducted to detect and monitor ADRs to anti-cancer agents, and to assess impact of clinical pharmacists (CPs)' interventions in minimizing ADRs to anti-cancer agents. Setting Private, specialty oncology care hospital in South India. Methods CPs prospectively followed cancer patients admitted to inpatient wards and treated at ambulatory care in order to identify ADRs, for a period of 3 years. Identified/reported ADRs were discussed with concerned oncologists and/or nurses, documented electronically and assessed further for their causality, severity, preventability and grading. Based on study findings during year 1, interventions (educational, therapeutic and system based) were developed by CPs and implemented in order to minimize preventable ADRs. Impact of CPs' interventions was studied during year 2 and year 3. Main outcome measure(s) Preventable factors contributing to ADRs and percentage of preventable ADRs before and after CPs' interventions. Results A total of 1279 ADRs were reported in 1133 patients from a cohort of 1328 patients. Vomiting (23.22%), alopecia (9.53%), diarrhoea (8.67%) and myelosuppression (7.42%) were the common ADRs reported. Inappropriate administration frequency and regimen of anti-emetics (22%), lack of/suboptimal supportive care (18%) and administration errors (16%) were identified as common contributing (preventable) factors for ADRs in year 1. Percentage of preventable ADRs was 81% during year 1 (pre-intervention), and 45% and 34% in year 2 and year 3 respectively (post-interventions). Conclusion Interventions by CPs helped to minimize preventable ADRs to anti-cancer agents. [ABSTRACT FROM AUTHOR]

Although more maternal deaths occur in the postpartum period, this period receives far less attention from the program managers. To understand how the women and their families perceive postpartum health problems, the culturally derived restrictions, and precautions controlling diets and behavior patterns, we conducted a mixed-method study in Rajasthan, India. The study methods included free listing of maternal morbidity conditions, interviews with 81 recently delivered women, case interviews with eight cases of huwa rog (postpartum illness), and interviews with nine key informants. The study showed that huwa rog refers to a broad category of serious postpartum illness, thought to affect women a few weeks to several months after delivery. Prevention of the illness involves a system of precautions referred to as parhej, which includes a distinctive set of “medicinal dietary items” referred to as desi dawai, or “country medicine,” and restrictions about mobility and work patterns of a postpartum woman. This cultural framework around the concept of huwa rog and peoples’ beliefs about it are of central importance for planning postpartum health interventions, including place of contact and communication messages. [ABSTRACT FROM AUTHOR]

Allopathic medical professionals in developed nations have started to collaborate with traditional, complementary, and alternative medicine (TCAM) to enquire on the role of religion/spirituality (r/s) in patient care. There is scant evidence of such movement in the Indian medical community. We aim to understand the perspectives of Indian TCAM and allopathic professionals on the influence of r/s in health. Using RSMPP (Religion, Spirituality and Medicine, Physician Perspectives) questionnaire, a cross-sectional survey was conducted at seven (five TCAM and two allopathic) pre-selected tertiary care medical institutes in India. Findings of TCAM and allopathic groups were compared. Majority in both groups (75 % of TCAM and 84.6 % of allopathic practitioners) believed that patients' spiritual focus increases with illness. Up to 58 % of TCAM and allopathic respondents report patients receiving support from their religious communities; 87 % of TCAM and 73 % of allopaths believed spiritual healing to be beneficial and complementary to allopathic medical care. Only 11 % of allopaths, as against 40 % of TCAM, had reportedly received 'formal' training in r/s. Both TCAM (81.8 %) and allopathic (63.7 %) professionals agree that spirituality as an academic subject merits inclusion in health education programs ( p = 0.0003). Inclusion of spirituality in the health care system is a need for Indian medical professionals as well as their patients, and it could form the basis for integrating TCAM and allopathic medical systems in India. [ABSTRACT FROM AUTHOR]

Although the use of yoga as a complementary therapy is common in palliative care, there is little evidence regarding current practice to inform service provision and research. The aim was to explore and compare yoga classes offered by palliative care services in New Delhi and London. Semi-structured qualitative interviews were conducted with yoga teachers and participants at two services and analysed thematically. Participants were: in Delhi eight family carers, three patients, and two teachers; in London six patients, one teacher, and one assistant. Six key themes are described: content of classes, symptoms and problems, preconceptions and the meaning of yoga, effects of yoga, challenges, and recommendations. This is the first study to examine the experiences of patients and carers practising yoga in palliative care settings. Recommendations include supporting and educating yoga teachers working with this population, and the need for robust trials. [ABSTRACT FROM AUTHOR]