Ethno-behaviorism and the culture-bound syndromes: The case of amok

The phenomenon of amok is reviewed in order to demonstrate the heuristic value of an ethno-behavioral model of culture-bound syndromes. The notion that culture-bound syndromes share underlying common disease forms is rejected. Instead, the ethno-behavioral model postulates that culture-bound syndromes consist of culturally specific behavioral repertoires legitimated by culturally sanctioned norms and concepts, but with both behavior and norms acquired in accordance with basic principles of human learning universal to all cultures. Consistent with this model, amok is shown to be a common behavioral pathway for multiple precipitants (which may or may not include disease pathology), but with a distinct form and conceptualization which can be traced to the social learning practices and beliefs of the Malay.[/p]     

Explanatory Models and Mental Health Treatment: Is Vodou an Obstacle to Psychiatric Treatment in Rural Haiti?

Vodou as an explanatory framework for illness has been considered an impediment to biomedical psychiatric treatment in rural Haiti by some scholars and Haitian professionals. According to this perspective, attribution of mental illness to supernatural possession drives individuals to seek care from houngan-s (Vodou priests) and other folk practitioners, rather than physicians, psychologists, or psychiatrists. This study investigates whether explanatory models of mental illness invoking supernatural causation result in care-seeking from folk practitioners and resistance to biomedical treatment. The study comprised 31 semi-structured interviews with community leaders, traditional healers, religious leaders, and biomedical providers, 10 focus group discussions with community members, community health workers, health promoters, community leaders, and church members; and four in-depth case studies of individuals exhibiting mental illness symptoms conducted in Haiti's Central Plateau. Respondents invoked multiple explanatory models for mental illness and expressed willingness to receive treatment from both traditional and biomedical practitioners. Folk practitioners expressed a desire to collaborate with biomedical providers and often referred patients to hospitals. At the same time, respondents perceived the biomedical system as largely ineffective for treating mental health problems. Explanatory models rooted in Vodou ethnopsychology were not primary barriers to pursuing psychiatric treatment. Rather, structural factors including scarcity of treatment resources and lack of psychiatric training among health practitioners created the greatest impediments to biomedical care for mental health concerns in rural Haiti.     

Obesity as a culture-bound syndrome

Although the term culture-bound syndrome has been used for many years, a concise definition has not been available. The less precise synonym folk illness has implied that such syndromes exist only in other cultures. This paper provides a four-part definition to permit examination and comparison of disease categories in any system, including biomedicine.Anthropologists have tended to view biomedicine as the standard for comparison, and have not examined it in the same critical light as other systems. This may be due in part to a confusion of the biomedical classificatory system (biomedicine per se, emic level) with the biological data on which in is based (etic level). One can in fact retain use of the biological data while analyzing biomedicine, which is understood to include cultural componentsMild-to-moderate obesity in the U.S. today fits the proposed definition of a culture-bound syndrome. This paper offers a brief overview of the evidence that culture has shaped both the definition of the disease over time and its treatment.     

Toxin or medicine? Explanatory models of radon in Montana health mines

Environmental protection and public health agencies in the United States and elsewhere label radioactive radon gas a toxic environmental hazard and a major cause of lung cancer. Paradoxically, in Europe and Japan radon gas is also used as an analgesic and anti-inflammatory, as one choice in the spectrum of conventional medical care. Although it is possible to find radon therapy in the United States, it exists only as an unconventional practice in Montana "radon health mines." In this article, I examine the use of radon therapy by Americans despite intensive public health education media campaigns. Using the notion of explanatory models as an analytical framework, I argue that American health mine clients adjust or replace "toxic models" of radon with new kinds of explanatory models that allow radon to be redefined as a healing substance. The manner of this adjustment varies according to peoples' individual needs, their own preexisting cultural models and experiences, and their individual personalities; the source of authoritative knowledge accepted by each person is a strong influence. Through these altered explanatory models, mine clients are able to view their use of radon therapy as a rational course of action.     

A hierarchical Bayesian approach for handling missing classification data

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Are Female Sex Workers Able to Negotiate Condom Use with Male Clients? The Case of Mobile FSWs in Four High HIV Prevalence States of India

Introduction

Condom promotion among female sex workers (FSWs) is a key intervention in India’s National AIDS Control Program. However, there is limited understanding of how FSWs negotiate condom use with male clients, particularly in the context of their mobility for sex work. The objective of this study is to examine the factors associated with the mobile FSWs’ ability to refuse unsafe sex and successfully negotiate condom use with unwilling male clients.

Methods

Data for 5498 mobile FSWs from a cross-sectional survey conducted in 22 districts of four states in southern India were analyzed. Questions assessed FSWs’ ability to refuse clients unprotected sex, convince unwilling clients for condom use and negotiate condom use in a new location. Logistic regression models were constructed to examine the association between socio-demographics, economic vulnerability, sex work practice, and program exposure and condom negotiation ability.

Results

A majority of FSWs (60%) reported the ability to refuse clients for unprotected sex, but less than one-fifth reported the ability to successfully convince an unwilling client to use a condom or to negotiate condom use in a new site. Younger and older mobile FSWs compared to those who were in the middle age group, those with longer sex work experience, with an income source other than sex work, with program exposure and who purchased condoms for use, reported the ability to refuse unprotected sex, to successfully negotiate condom use with unwilling clients and to do so at new sites.

Conclusion

FSWs need to be empowered to not only refuse unprotected sex but also to be able to motivate and convince unwilling clients for condom use, including those in new locations. In addition to focusing on condom promotion, interventions must address the factors that impact FSWs’ ability to negotiate condom use.     

Hwabyung: The construction of a korean popular illness among korean elderly immigrant women in the United States

The cultural construction of Hwabyung, a Korean culture-bound syndrome, is explored among a sample of 20 elderly Korean immigrant women in the United States. Hwabyung results when distressed emotions associated with the specifically Korean way of perceiving and reacting to intolerable and tragic life situations cause bodily symptoms by interfering with the harmony of Ki (vital energy). Korean elderly immigrants report a broad range of symptoms associated with Hwabyung; they less frequently report the epigastric mass, which had been considered the cardinal symptom by cosmopolitan and traditional medical writers. Hwabyung is treated holistically with psychosocial support from family, spiritual comfort, home and popular remedies, traditional Korean medicine, and biomedical treatments. Hwabyung provides a way of conceptualizing and resolving emotional distress through somatization among Korean elderly immigrant women.     

Prey diversity as a driver of resource partitioning between river‐dwelling fish species

Although food resource partitioning among sympatric species has often been explored in riverine systems, the potential influence of prey diversity on resource partitioning is little known. Using empirical data, we modeled food resource partitioning (assessed as dietary overlap) of coexisting juvenile Atlantic salmon (Salmo salar) and alpine bullhead (Cottus poecilopus). Explanatory variables incorporated into the model were fish abundance, benthic prey diversity and abundance, and several dietary metrics to give a total of seventeen potential explanatory variables. First, a forward stepwise procedure based on the Akaike information criterion was used to select explanatory variables with significant effects on food resource partitioning. Then, linear mixed‐effect models were constructed using the selected explanatory variables and with sampling site as a random factor. Food resource partitioning between salmon and bullhead increased significantly with increasing prey diversity, and the variation in food resource partitioning was best described by the model that included prey diversity as the only explanatory variable. This study provides empirical support for the notion that prey diversity is a key driver of resource partitioning among competing species.     

Engineering of microscale three-dimensional pancreatic islet models in vitro and their biomedical applications

Diabetes now is the most common chronic disease in the world inducing heavy burden for the people's health. Based on this, diabetes research such as islet function has become a hot topic in medical institutes of the world. Today, in medical institutes, the conventional experiment platform in vitro is monolayer cell culture. However, with the development of micro- and nano-technologies, several microengineering methods have been developed to fabricate three-dimensional (3D) islet models in vitro which can better mimic the islet of pancreases in vivo. These in vitro islet models have shown better cell function than monolayer cells, indicating their great potential as better experimental platforms to elucidate islet behaviors under both physiological and pathological conditions, such as the molecular mechanisms of diabetes and clinical islet transplantation. In this review, we present the state-of-the-art advances in the microengineering methods for fabricating microscale islet models in vitro. We hope this will help researchers to better understand the progress in the engineering 3D islet models and their biomedical applications such as drug screening and islet transplantation.     

Salivary flow rate and risk of malnutrition – a study among dentate,community‐dwelling older people

doi: 10.1111/j.1741‐2358.2012.00679.x Salivary flow rate and risk of malnutrition – a study among dentate, community‐dwelling older people Objective: To analyse the relation between unstimulated and stimulated salivary secretion and the risk of malnutrition among home‐dwelling elderly people. Background: Saliva has an important role in eating. Despite this, there are only a few studies on the role of salivary secretion in the development of malnutrition among elderly people. Materials and methods: The study population consisted of 157 subjects aged 75 or older. This was a part of GeMS study carried out in Kuopio, in eastern Finland. The data used in this study were collected by means of interviews and geriatric and oral clinical examinations. The risk of malnutrition was measured using the Mini Nutritional Assessment Short‐Form. Logistic regression models were used to estimate odds ratios (OR) and their 95% Confidence Intervals (CI). Results: Subjects with a low unstimulated salivary flow rate (<0.1 ml/min) or stimulated salivary flow rate (<1.0 ml/min) had no statistically significant increase in risk of malnutrition, OR: 1.3, CI: 0.5–3.9, OR: 1.5, CI: 0.5–4.2, respectively, when compared with those with a normal unstimulated and stimulated salivary flow rate. Conclusion: Our results do not support the concept that low salivary secretion is an important risk factor for malnutrition among community‐dwelling elders.     

Beyond reified categories: multidimensional identifications among ‘black’ and ‘Indian’ groups in Columbia and Mexico

Analyses of multicultural state-dictated social categories are often governed by those same categories, even while they deconstruct them. Nonetheless, these categories are often used in public spheres such as national imaginary or ethno-political activism. Taking a different point of departure, that of representations rather than the categories themselves, the aim of our paper is to understand the modes of classification that are relevant among four populations in Colombia and Mexico who would, a priori, be categorized as ‘black’ or ‘Indian’. The daily reality of these groups indicates other possible internal, sometimes even intersecting, kinds of categorizations, which, far from naturalizing the ‘Indian’ and ‘black’ categories, in fact reveal place-based social identifications. These identifications seem closer to the everyday lives and practices of the people in question, and underscore the local conceptions of their presence and agency in a given spot.     

Prevention. How much harm? How much benefit? 1. Influence of reporting methods on perception of benefits.

Before a physician or a patient can decide whether a preventive program is worth while, each must understand the nature and degree of its benefits and the frequency and magnitude of its adverse effects. Preventive interventions can be divided into two major categories: those with infrequent or minor adverse effects and those with adverse effects that are frequent or serious. Accident prevention, avoidance of high-risk behaviour and healthy lifestyle choices such as breast-feeding and moderate exercise are associated with few adverse consequences. By contrast, screening populations for disease, risk classification for the purpose of selective preventive interventions, dietary intervention and prophylactic drug treatment may lead to more frequent and serious adverse effects. When assessing whether the benefits of a preventive intervention outweigh the harm, one must be aware that the methods used to report benefits of clinical trials may distort the reader''s perception of their magnitude. The relative reduction of morbidity or mortality rate often grossly exaggerates benefits and should never be used as a basis for clinical decision making. More realistic ways of recording benefits are the absolute reduction of morbidity or mortality rate, the number of patients that need to be treated to avoid one adverse event, and the total cohort mortality rate.     

Coping with fertility in Israel: A case study of culture clash

The concepts of culture-bound belief systems and explanatory models focused on reproduction and contraception are applied to a case of a married Jewish woman seeking to interrupt an unwanted pregnancy. Discrepancies between the lay belief system held by the woman, and the clinical belief system of the medical mediators of contraception and abortion, have created a situation where none of the alternatives at the woman's disposal seems correct: the options available for preventing pregnancy are unacceptable or inefficient; having a child is also not acceptable; and termination of unwanted pregnancy by abortion is ethically and morally wrong. The "no-win" situation results from medical ethnocentrism and failure to interpret the context of meanings and norms within which health decisions are constructed.     

Accounting for the nested nature of genetic variation across levels of organization improves our understanding of biodiversity and community ecology

Recent work has demonstrated that the presence or abundance of specific genotypes, populations, species and phylogenetic clades may influence community and ecosystem properties such as resilience or productivity. Many ecological studies, however, use simple linear models to test for such relationships, including species identity as the predictor variable and some measured trait or function as the response variable without accounting for the nestedness of genetic variation across levels of organization. This omission may lead to incorrect inference about which source of variation influences community and ecosystem properties. Here, we explicitly compare this common approach to alternative ways of modeling variation in trait data, using simulated trait data and empirical results of common‐garden trials using multiple levels of genetic variation within Eucalyptus, Populus and Picea. We show that: 1) when nested variation is ignored, an incorrect conclusion of species effect is drawn in up to 20% of cases; 2) overestimation of the species effect increases – up to 60% in some scenarios – as the nested term explains more of the variation; and 3) the sample sizes needed to overcome these potential problems associated with aggregating nested hierarchical variation may be impractically large. In common‐garden trials, incorporating nested models increased explanatory power twofold for mammal browsing rate in Eucalyptus, threefold for leaf area in Populus, and tenfold for branch number in Picea. Thoroughly measuring intraspecific variation and characterizing hierarchical genetic variation beyond the species level has implications for developing more robust theory in community ecology, managing invaded natural systems, and improving inference in biodiversity–ecosystem functioning research. Synthesis Until recently, ecologists acknowledged the ubiquity of within‐species trait variation, but paid scant attention to how much it affects communities and ecosystems. Here, the authors used simulated trait data and common‐garden studies to demonstrate that we ignore intraspecific trait variation at our peril. In both simulated and experimental systems, in many cases ignoring intraspecific variation led to incorrect statistical inferences and inflated the effect size of species identity. This study shows that ecologists must characterize hierarchically nested genetic and phenotypic variation to fully understand the links between individual traits, community structure and ecosystem functioning.     

Can Andean medicine coexist with biomedical healthcare? A comparison of two rural communities in Peru and Bolivia

ABSTRACT: BACKGROUND: It is commonly assumed that indigenous medical systems are strong in developing countries because biomedicine is physically inaccessible or financially not affordable. This paper compares the health-seeking behavior of households from rural Andean communities at a Peruvian and a Bolivian study site. The main research question was whether the increased presence of biomedicine led to a displacement of Andean indigenous medical practices or to coexistence of the two healing traditions. Methodology: Interviews were conducted between June 2006 and December 2008 with 18 households at each study site. Qualitative identification and analysis of households' therapeutic strategies and use of remedies was complemented by quantitative assessment of the incidence of culture-bound illnesses in local ethnobiological inventories. RESULTS: Our findings indicate that the health-seeking behavior of Andean households is independent of the degree of availability of biomedical facilities in terms of quality of services provided, physical accessibility, and financial affordability, except for specific practices such as childbirth. Preference for natural remedies over pharmaceuticals coexisted with biomedical healthcare that was both accessible and affordable. Furthermore, our results show that greater access to biomedicine does not lead to less prevalence of Andean indigenous medical knowledge, as represented by the levels of knowledge about culture-bound illnesses. CONCLUSIONS: The take-home lesson for health policy-makers from this study is that the main obstacle to improved use of biomedicine in resource-poor rural areas might not be infrastructural or economic alone. Rather, it may lie in lack of sufficient recognition by biomedical practitioners of the value and importance of indigenous medical systems. We propose that the implementation of health care in indigenous communities be designed as a process of joint development of complementary knowledge and practices from indigenous and biomedical health traditions.     

Health beliefs and hypertension: A case-control study in a Moroccan Jewish community in Israel

This research focuses on the efficacy of health interventions and patient-physician negotiation in modifying patient belief models and influening compliance behavior. It is an example of clinically applied anthropology in the Hadassah Family Practice Clinic of Beit Shemesh, Israel. Forty-six Moroccan Jewish hypertensives and normotensives were interviewed using a semi-structured questionnaire. Explanatory models of hypertension were elicited. In addition, the results from all questionnaires were scored according to the Health Belief Model Equation and correlated with each individual's assessed compliance. The only positive correlation, significant to p < 0.05, was found among hypertensives: a correlation between the degree of compliance and the congruence of the individual's health belief model with that of the health provider. The authors conclude that hypertensive health belief and explanatory models were not perceptibly affected by health care intervention. The congruence of the patient's health belief model with that of the health provider may be predictive of compliance.     

Gametes as embodied capital: perceptions on self-pricing reproductive biocommodities

The exchange of gametes has polarized and captivated the attention of biomedical practitioners, policy stakeholders, ethicists, and the general public alike. Studies have thoroughly explored the unique histories of this industry, its economies, legal statutes that influence clinical practice, motivating factors of donors, as well as debates on differentiating donor, offspring, and family rights from each other. This mixed-method study refocuses the analytical lens to examine the perceptions and decision-making processes of individual willingness to participate in gamete exchange networks in the United States for procreative or research purposes. Analyses revealed that individuals engage in a form of self-biocommodification, where ascribed values of gametes are explained as embodied capital and rationalized by Western biomedical explanatory models of genetics and reproduction. This work contributes to social scientific explanations of biocommodification while providing new points of departure in reconceptualizing science and technology studies through the perspectives of potential actors in gamete exchange networks.     

Impact of twenty-first century climate change on diadromous fish spread over Europe, North Africa and the Middle East

Climate change is expected to drive species ranges towards the poles and to have a strong influence on species distributions. In this study, we focused on diadromous species that are of economical and ecological importance in the whole of Europe. We investigated the potential distribution of all diadromous fish regularly encountered in Europe, North Africa and the Middle East (28 species) under conditions predicted for twenty‐first century climate change. To do so, we investigated the 1900 distribution of each species in 196 basins spread across all of Europe, North Africa and the Middle East. Four levels were used to semiquantitatively describe the abundance of species, that is missing, rare, common and abundant. We then selected five variables describing the prevailing climate in the basins, the physical nature of the basins and reflecting historical events known to have affected freshwater fish distribution. Logistic regressions with a four‐level ordinal response variable were used to develop species‐specific models. These predictive models related the observed distribution of these species in 1900 to the most explanatory combination of variables. Finally, we selected the A2 SRES scenario and the HadCM3 (Hadley Centre Coupled Model version 3) global climate model (GCM) to obtain climate variables (temperature and precipitation) at the end of this century. We used these 2100 variables in our models and obtained maps of climatically suitable and unsuitable basins, percentages of contraction or expansion for each species. Twenty‐two models were successfully built, that is there were five species for which no model could be established because their distribution range was too narrow and the Acipenser sturio model failed during calibration. All the models selected temperature or/and precipitation as explanatory variables. Responses to climate change were species‐specific but could be classified into three categories: little or no change in the distribution (five species), expansion of the distribution range (three species gaining suitable basins mainly northward) and contraction of the distribution (14 species losing suitable basins). Shifting ranges were in accordance with those found in other studies and underlined the high sensitivity of diadromous fish to modifications in their environment.