Mental health services and traditional healing in Indonesia: Are the roles compatible?

This study reports on the presentation of illness complaints by 90 individuals to nine traditional healers in three Indonesian cities. Focus is on the nature of problems, client explanations and expectations, healer treatment and subsequent outcome as judged by clients. Selected clients were observed and interviewed by a psychiatrist and one other health professional, and followed in a subsequent home visit. Complaints were categorized according to dimensions of acuteness and chronicity of problem, presumed self-limited characteristics, and psychological, general medical and other factors. Sixty-five percent of all clients had received prior treatment for the same problem in a biomedical health care setting. The study holds practical implications for policies regarding relations between health and mental health services and traditional healers in Indonesia. The authors wish to acknowledge support from the following institutions; The Institute for Health Research and Development, Ministry of Health, Republic of Indonesia (LITBANGKES) for financial support; The Asia Foundation, Jakarta; The World Health Organization, Southeast Asia Office; The Cultural Learning Institute, East West Center, Honolulu, Hawaii.     

Health Canada/BIOTECanada Summit on regulatory and clinical topics related to subsequent entry biologics (biosimilars), Ottawa,Canada, 14 May 2012

In May 2012, Health Canada and other participants held a National Summit on Subsequent Entry Biologics (SEBs). Health Canada released a guidance document in March 2010 describing policy positions and data requirements for approval of SEBs. While Health Canada and health agencies in other regulatory jurisdictions are aligned on many scientific principles related to biosimilar drugs, Health Canada's specific requirements may not be widely understood by many Canadian stakeholders. The Summit provided an opportunity for education and dialog among physicians who prescribe biologics, provincial payers, and industry on the following topics: preclinical and clinical comparability studies; manufacturing and other product differences; extrapolation of indications; substitution and interchangeability of SEBs with reference biologic drugs in clinical practice; payers' current perspective; pharmacovigilance and naming. It is anticipated that the consensus reached at this meeting will further educate Canadian healthcare professionals, provincial payers, and insurers about the appropriate use of SEBs, and may be of general interest to others internationally.     

Review of "Biomedical Informatics; Computer Applications in Health Care and Biomedicine" by Edward H. Shortliffe and James J. Cimino

This article is an invited review of the third edition of "Biomedical Informatics; Computer Applications in Health Care and Biomedicine", one of thirty-six volumes in Springer's 'Health Informatics Series', edited by E. Shortliffe and J. Cimino. This book spans most of the current methods and issues in health informatics, ranging through subjects as varied as data acquisition and storage, standards, natural language processing, imaging, electronic health records, decision support, teaching methods and ethics. The book is aimed at 'healthcare professionals', and is certainly appropriate for the non-technical informatics user. However, this book is also excellent background reading for the technical engineer who may be interested in the possible problems that confront the users in this field.     

A Rock in a hard place

Federal Minister of Health Allan Rock appears committed to improved funding for the health care system, but this may be a hard sell in cabinet. He outlined his views during the CMA''s recent annual meeting in Whitehorse.     

The Development and Organization of a Children's Psychiatric Hospital

Thistletown Hospital is a children''s psychiatric hospital which was established by the Department of Health of the Province of Ontario. Special legislation permitting control of the admissions procedures was enacted. The administrative organization consists of a series of committees made up of the heads of hospital departments. An advisory board of distinguished psychiatrists and psychologists advises the Minister of Health directly on major policy changes or innovations envisaged for the hospital. Clinical organization is related to four functions: (1) service (treatment and assessment), (2) research, (3) training of staff, and (4) community education.The basic units of the hospital are related to the treatment or research design necessary in special diagnostic categories. A children''s psychiatric hospital should not be restricted to in-patient facilities but should consist of a totally community-oriented service.     

Cytotoxic activity and mechanism of action of metabolites from the Goniothalamus genus

The World Health Organization estimates that 4 billion people or 80 % of the population use plants for curative purposes or for their natural health benefits. Accordingly, biodiversity is an important source of active natural products especially used in traditional medicine as healers transmitted knowledge of traditional usage of medicinal plants from generation to generation whereas pharmacologically active compounds within remained obscure. The present review documents cytotoxicity and anti-cancer potential of known compounds of the Goniothalamus species from the Annonaceae family existing in tropical and subtropical Asia and being intensively used for medicinal purposes.     

A system worth saving.

The country will mark Canada Health Day on May 12, so CMAJ asked Dr. Michael Gordon to reflect on Canada''s health care system and the changes it has seen and will see. The special day, cosponsored by the Canadian Public Health Association, is designed to highlight "the need for better communication between health professionals and the communities they serve." In this article, Gordon reflects on the dangers facing Canada''s medicare system and the need to protect it from the inroads threatened by privatization.     

Use of personal medical records for research purposes.

The established practice of doctors using medical records for research purposes is threatened by the recent proposed guidelines from the Department of Health, the BMA, and the European Commission. The European Commission has proposed that explicit consent should be obtained from each patient before his or her medical records can be used; the proposals from the Department of Health and the BMA would require all research that needs access to personal medical records to be submitted to an ethics committee. We believe that these proposals would seriously impair an entire category of research and suggest therefore that another set of guidelines, proposed by a Royal College of Physicians'' working group, should be used to modify the proposals. The guidelines of the working group encourage the use of medical records for research and ensure that such use can be made in a confidential manner without causing harm.     

Development of an immunoenzyme method for detection and quantitative determination of microcystins

An indirect competitive immunoenzyme method for the quantitative estimation of microcystins (MCs) in water (MC-ELISA) using prepared MC-specific polyclonal antibodies was developed. The threshold concentration of the most widespread and highly toxic MC-LR, which was reliably detected using MC-ELISA, was 0.05 ± 0.01 ng/mL; the 50% inhibition concentration was 0.41 ± 0.05 ng/mL; and the concentration range for the quantitative estimation of MC-LR was 0.1–5.0 ng/mL. The MC-ELISA made it possible to detect MC-LR in water at concentrations 10–20 times lower than the World Health Organization guideline level for drinking water and 100–200 times lower than the allowable MC concentrations in water bodies. A group of cross-reacting MCs and nodularin was detected using MC-ELISA. This method can be applied for monitoring MC concentrations in water bodies and drinking water.     

The Role of the University in Modern Society

President Odegaard here presents some stimulating thoughts for medical educators and for other members of the medical profession. Although a historian by profession, he has considerable familiarity with medical matters from his membership in the Citizens Commission on Graduate Medical Education (Millis Commission), the President''s National Advisory Commission on Health Manpower and the Natonal Advisory Health Council.     

Impact of hormone therapy for women aged 35 to 65 years,from contraception to hormone replacement

Background: Midlife women (aged 35–65 years) present a complex combination of clinical challenges and health care opportunities. To meet these issues effectively, recognition of the various phases of the entire menopausal transition is necessary, because each possesses unique biological properties underlying phase-specific clinical presentations.Objective: The aim of this article is to inform health care decisions by defining the endocrine, metabolic, and clinical consequences of therapeutic inaction or intervention at each stage of the midlife experience.Methods: Using PubMed, MEDLINE was searched for age- and phase-specific publications about ovarian function and corresponding clinical manifestations in women aged 35 to 65 years. Large, long-term longitudinal prospective, case-control, and observational studies were selected for inclusion. Results of the Framingham Heart Study, Study of Women's Health Across the Nation, Nurses' Health Study (NHS), and Women's Health Initiative (WHI), as well as materials from the World Health Organization and American College of Obstetricians and Gynecologists, were obtained from the relevant groups' Web sites in 2008.Results: Synthesis of the data acquired, particularly the confirmatory and contrasting elements displayed in the WHI and NHS publications, leads to a set of guiding principles whereby individualized phase-specific management strategies may be safely employed. These include the value of weight control and exercise; use of specific nonhormonal therapies for defined indications; definition of strict inclusion/exclusion criteria; and individualization of timing, regimen, dosage, and portal of entry for possible hormone therapy.Conclusion: An evidence-based, restrictive inclusion/exclusion strategy can be used to maximize benefits and minimize risks for this large, growing, and health-conscious but increasingly vulnerable population.     

Requests approaching 50,000 annually for emergency drug release program.

Health Canada''s Emergency Drug Release Program, which allows physicians to acquire nonmarketed drugs to treat people with HIV infection, AIDS and other illnesses, handles about 44 000 requests annually. The executive director of the Drugs Directorate says the program''s name is a misnomer, since few of the requests involve medical emergencies. Dr. Philip Berger, who uses the program for his AIDS patients, complains that the amount of paperwork required is oppressive. A government spokesperson says changes may be made to make the program less labour intensive.     

‘Through a Glass Darkly’: The Rockefeller Foundation's International Health Board and Soviet Public Health

In the early 1920s, the Rockefeller Foundation's International Health Board was presenting itself as the watchtower of public health for the world at large. Yet Soviet Russia was never included in any of the International Health Board's programs, despite the efforts of the Russians to reach out to the Board. This paper examines the exclusion of Russia as a function of the conceptual and structural lenses through which the International Health Board ‘saw’ post-revolutionary Soviet public health. It also speculates about the ways in which those who spoke on behalf of Soviet public health contributed to the perceptions of the Board.     

The National Forum reports: Crisis? What crisis?

The National Forum on Health''s final report appears to have said what Canadians--and the federal Liberal government wanted to hear about the health care system. It called for preservation of the single-payer model and the 5 principles of the Canada Health Act, and also recommended that medicare be expanded to embrace pharmaceuticals and home care. Edmonton internist Tom Noseworthy, chair of the forum''s steering committee, said public anxiety about medicare is caused by the rapid pace of change, not its direction. However, the CMA''s Dr. Judith Kazimirski was quick to challenge Noseworthy and his criticism of those who say a crisis exists.     

The New Health Practitioner — The Past as Prologue

The training and utilization of New Health Practitioners (NHP''s) has moved within a decade from a small tentative beginning in the mid-1960''s to a major health manpower policy issue. Its discussion transcends a number of important and emotionally charged areas including the role of various professions in providing health care services, the renaissance of primary care, the geographic and economic maldistribution of medical services, and the cost of care. It is valuable to highlight what is known, what is professed and what needs to be studied further about this issue.     

Efficiency and the Public's Health

The Governor''s Survey on Efficiency and Cost Control, established by Governor Reagan''s executive order, was a non-profit, bipartisan, privately financed management analysis of State administration conducted by private citizens, including physicians, during 1967 for the purpose of achieving improvement in administrative procedure and operating economies in State government.State employees and appointed department heads offered many valuable suggestions and cooperated fully with the survey team.Two hundred recommendations were submitted to the Governor for improvement in the Departments of Public Health and Mental Hygiene, the Office of Health Care Services and the organizations under the Secretary of Human Relations.The recommendations for the health-related administrative units concerned reorganization and consolidation of departments and units, improvement in administrative and operating methods and improvement of services. Annual savings of several hundred million dollars could result.None of the recommendations were for reduction in services and none concerned individual employees or appointees.Assistance in and support for the implementation of the recommendations will be needed from legislators, responsible citizens and organizations interested in efficient and economical government.     

Long term conservation of human metabolic phenotypes and link to heritability

Changes in an individual’s human metabolic phenotype (metabotype) over time can be indicative of disorder-related modifications. Studies covering several months to a few years have shown that metabolic profiles are often specific for an individual. This “metabolic individuality” and detected changes may contribute to personalized approaches in human health care. However, it is not clear whether such individual metabotypes persist over longer time periods. Here we investigate the conservation of metabotypes characterized by 212 different metabolites of 818 participants from the Cooperative Health Research in the Region of Augsburg; Germany population, taken within a 7-year time interval. For replication, we used paired samples from 83 non-related individuals from the TwinsUK study. Results indicated that over 40 % of all study participants could be uniquely identified after 7 years based on their metabolic profiles alone. Moreover, 95 % of the study participants showed a high degree of metabotype conservation (>70 %) whereas the remaining 5 % displayed major changes in their metabolic profiles over time. These latter individuals were likely to have undergone important biochemical changes between the two time points. We further show that metabolite conservation was positively associated with heritability (rank correlation 0.74), although there were some notable exceptions. Our results suggest that monitoring changes in metabotypes over several years can trace changes in health status and may provide indications for disease onset. Moreover, our study findings provide a general reference for metabotype conservation over longer time periods that can be used in biomarker discovery studies.