- Email: [email protected]
International cooperation in support of complementary medicine integration in developing countries: the Tuscany–Serbia experience
Oral Presentations / European Journal of Integrative Medicine 4S (2012) 9–123
phy. Tests include total ash, loss on drying, etc. A specific and validated assay, wherever possible, is included, generally liquid chromatography (LC) and gas chromatography (GC) are methods of choice to determine the content of specific constituents rather than a global determination by spectrophotometry using external or internal suitable reference standards. http://dx.doi.org/10.1016/j.eujim.2012.07.725 OP-231 Towards a European regulatory framework for medicinal products with a whole system background Baars Erik, Hamre Harald Louis Bolk Institute, Driebergen, the Netherlands The European Union (EU) has a policy to improve the health of its citizens and to guarantee the sustainability of the health-care systems in its member states. One topic currently insufficiently met by the EU is the testing and licensing of medicinal products (MPs) with a ‘whole system’ background (e.g., anthroposophic medicine and traditional Chinese medicine). Whole medical systems can be defined as approaches to health care in which practitioners apply system-specific knowledge and experience in order to maximise the patients’ capacity to achieve mental and physical balance and restore their own health, using individualised, non-reductionist approaches to diagnosis and treatment. In whole systems, a long-standing practitioner–patient relationship and an optimised therapeutic environment may play a central role. Conventional MPs are developed in the laboratory and subsequently tested in preclinical studies, phase 1–3 clinical studies and, finally, in clinical practice. In routine practice, conventional MPs are mostly used according to a fixed schedule and for one indication. Conversely, MPs with a whole system background are developed in clinical practice with regard to the principles of the respective medical system, most often have a long tradition of use, are often selected individually to address the needs of each patient on the basis of trained judgement skills of the health practitioner and are often used in combination with other MPs or nonpharmacological therapies. Within the scientific community, a consensus is emerging for an alternative-testing programme to study intact, whole systems in their complexity in order to mirror real-world practice. The assessment starts with the context, theoretical background and real-world application of the system, followed by a safety evaluation, then a pragmatic evaluation of the effectiveness of the whole system and, finally, an exemplary evaluation of some isolated components and their mechanisms of action. The current regulatory frameworks in the EU member states are not appropriate for this testing approach to MPs with a whole system background. In this presentation, based on the scientific literature on whole systems research, we propose a framework for a permanent licensing system for ‘whole system MPs’ in Europe, including models for evidence grading and licensing categories. http://dx.doi.org/10.1016/j.eujim.2012.07.726
109
OP-232 Moringa oleifera (Horseradish tree): tree for life De Monte Teresa International Association Yoga & Ayurveda, Artegna-Udine, Italy Moringa oleifera is known for centuries by developing nations as an important nutritional supplement with a variety of medicinal properties. Unlike other nutritional supplements, Zija provides very low-calorie, quality protein dietary supplementation (containing 19 of the 20 most common amino acids). This study investigates primary food source versus nutritional supplementation, Moringa leaf powder versus malnutrition, as supplementary feeding of human beings. M. oleifera is a chemoprotective, the International Consensus Conference (February 05) affirms: an edible plant-based approach to Helicobacter pylori treatment. In addition, M. oleifera shows the beneficial effect of its ethanolic extract on osteoporosis, considerable promise as a lower-carbohydrate, lower-fat alternative to common liquid dietary supplements and may serve to reverse the effects of many nutrient-depleting prescription and non-prescription drugs. With significant botanical and medical published research in both the academic and the scientific literature, and with substantial ongoing research from the international community, the addition of M. oleifera into the daily diet shows considerable promise as an adjunct to improving health in a variety of important ways. http://dx.doi.org/10.1016/j.eujim.2012.07.727 INTERNATIONAL HEALTH CO-OPERATION OP-233 International cooperation in support of complementary medicine integration in developing countries: the Tuscany–Serbia experience Rossi Elio 1 , Di Stefano Mariella 1 , Baccetti Sonia 2 , Stambolovich Vuk 1,2 1 Ambulatory
of Homeopathy, Local Health Unit of Lucca
2 Fior di Prugna Referring Center for Complementary Medicine
of Tuscany Region, Local Health Unit of Florence, Florence, Italy Objective: The objective of this article is to describe the international health cooperation programmes of the Tuscany Region in Italy supporting the development of complementary, traditional medicine (CTM) in the southern countries of the world. Methods: Projects for decentralised cooperation have been realised in Cuba, Senegal, Serbia and with the Saharawi population of Sahara, with the cooperation of local bodies, international institutions, associations and non-governmental organisations (NGOs). An international seminar on ‘Innovation and Development in the Health System: Inclusion of Complementary and Traditional Medicine in the Public Health System’ was held in Florence in October 2008, with the participation of delegates
110
Oral Presentations / European Journal of Integrative Medicine 4S (2012) 9–123
and experts from 26 countries, NGOs and the agencies of the United Nations. Results: Activities of health cooperation of the Tuscany Region with Cuba were launched in 1994, within the framework of natural and unconventional medicine, and in particular of homeopathic medicine. The veterinary and human homeopathy project with the Saharawi people has been active since 1997. In 2001, acupuncture and traditional Chinese medicine were included in the project ‘Fight against maternal and child mortality’ in Senegal. In 2008, Tuscan Region Referral Centres for Complementary Medicine started the project of international cooperation ‘Support to the Integration of Complementary Medicine in the National and Regional Health System of Serbia’, approved by the Tuscany Region in July 2007 and promoted by the ‘Fior di Prugna’ Centre, in collaboration with the Regional Homeopathy Referral Centre in Lucca, the Serbian Institute of Social Medicine, the University of Belgrade and the ART/UNDP Programme. The aim of the project is to support a strategy of inclusion of complementary medicine in the public health system, to finance a survey on the use of these therapies in the country and to support their inclusion in natural delivery, oncology, assistance to the elderly and palliative treatment. A further aim of this project is the support to physiological delivery at the hospital of Panˇcevo, in the Voivodina Region, which had resulted in mutual missions of doctors and obstetricians to Italy and Serbia. Conclusions: CTM can represent a useful and sustainable resource in different fields of health care. International health cooperation should include programmes supporting the integration of complementary medicine in the public health system in developing countries http://dx.doi.org/10.1016/j.eujim.2012.07.728 OP-234 The global patient’s illness representations as a dialectic referent for interprofessional practice: analysis of the articulation of a plurality of voices and choices in a Canadian integrative health-care clinic Bujold Mathieu Laval University, Quebec, QC, Canada Background: In the past decade, North America has witnessed the emergence of clinics, in which practitioners of different clinical backgrounds (alternative, biomedical) offer integrative health care (IHC) in a spirit of cooperation centred on the whole person. Despite a growing research interest on this kind of organisation, no study has yet analysed in situ the negotiation of viewpoints in the IHC process, taking into account the patient’s illness representations, and even less situating this dynamic in its sociocultural context. Aim: This study aimed to analyse the articulation of a plurality of attitudes in a Canadian integrative health-care clinic. Methods: During a 2-year field study in a Canadian IHC cooperative, grouping together 14 alternative and biomedical practitioners, the therapeutic experiences of 15 chronically ill
patients were examined longitudinally. The objective of this study was to identify and analyse the factors that either foster or impede articulation of viewpoints in an IHC process. The conceptual framework, with its innovative dynamic use of individual explanatory models (iEMs), made it possible to analyse the dynamic interaction between the perceptions of the actors involved in the IHC. Different sources and tools were used in the data collection period in this centre that has been divided into two phases: the first, which we describe as ethnographic, was to accumulate information about the structure of the organisation and operation, using interviews, observations and collections of documents. The second phase consisted of following part of the therapeutic itinerary of patients starting or having recently begun a process of IHC in this centre. A total of 120 h of recording around IHC in this clinic was collected (patient and practitioner interviews, clinical encounters, interprofessional meetings, etc.). Results and discussion: The data analysis shows that the different versions of patient iEM could provide interdisciplinary referents, thus reducing some constraints relating to idiomatical and epistemological diversities. One of the theoretical contributions of this study is that it refines our understanding of the concept of iEM, stressing, among other things, their polymorphic nature. The preconception that the patient has about the practitioner and his practice seems to have a great impact on the way he/she will present his iEM in a clinical encounter. Beyond the fact that it is in keeping with a central postulate of IHC, recognising the importance of the patient’s viewpoints also appears to facilitate the transition from multidisciplinary to interdisciplinary teamwork. http://dx.doi.org/10.1016/j.eujim.2012.07.729 OP-235 Socio-epidemiological research on health behaviour in the Louga Region–Senegal: innovation and scientific tradition towards a better comprehension of the use of health resources Filieri Marcella 1 , Bastiani Luca 2 , Curzio Olivia 2 , Baldini Iside 3 , Traorè Mahamed 4 , Ndeye Edouard Jr 5 , Diakhoumpa Ndongo 6 , Grillo Andrea 7 , Molinaro Sabrina 2 1 Local
Health Unit 5 of Pisa, Pisa, Italy
2 Institute of Clinical Physiology, National Council of Research,
Pisa, Italy 3 Community Development Volunteer Commitment - CISV Turin,
Italy 4 Region Medical Director Louga, Senegal 5 Community Development Volunteer Commitment - CISV Turin, Italy 6 President AMPHOT Louga, Senegal 7 Local Health Care Service 6 Livorno, Italy Background: The World Health Organisation (WHO) recommends that traditional medicine be included in health plans of all countries to improve the strategy for the integration of traditional medicine in modern health-care systems.
phy. Tests include total ash, loss on drying, etc. A specific and validated assay, wherever possible, is included, generally liquid chromatography (LC) and gas chromatography (GC) are methods of choice to determine the content of specific constituents rather than a global determination by spectrophotometry using external or internal suitable reference standards. http://dx.doi.org/10.1016/j.eujim.2012.07.725 OP-231 Towards a European regulatory framework for medicinal products with a whole system background Baars Erik, Hamre Harald Louis Bolk Institute, Driebergen, the Netherlands The European Union (EU) has a policy to improve the health of its citizens and to guarantee the sustainability of the health-care systems in its member states. One topic currently insufficiently met by the EU is the testing and licensing of medicinal products (MPs) with a ‘whole system’ background (e.g., anthroposophic medicine and traditional Chinese medicine). Whole medical systems can be defined as approaches to health care in which practitioners apply system-specific knowledge and experience in order to maximise the patients’ capacity to achieve mental and physical balance and restore their own health, using individualised, non-reductionist approaches to diagnosis and treatment. In whole systems, a long-standing practitioner–patient relationship and an optimised therapeutic environment may play a central role. Conventional MPs are developed in the laboratory and subsequently tested in preclinical studies, phase 1–3 clinical studies and, finally, in clinical practice. In routine practice, conventional MPs are mostly used according to a fixed schedule and for one indication. Conversely, MPs with a whole system background are developed in clinical practice with regard to the principles of the respective medical system, most often have a long tradition of use, are often selected individually to address the needs of each patient on the basis of trained judgement skills of the health practitioner and are often used in combination with other MPs or nonpharmacological therapies. Within the scientific community, a consensus is emerging for an alternative-testing programme to study intact, whole systems in their complexity in order to mirror real-world practice. The assessment starts with the context, theoretical background and real-world application of the system, followed by a safety evaluation, then a pragmatic evaluation of the effectiveness of the whole system and, finally, an exemplary evaluation of some isolated components and their mechanisms of action. The current regulatory frameworks in the EU member states are not appropriate for this testing approach to MPs with a whole system background. In this presentation, based on the scientific literature on whole systems research, we propose a framework for a permanent licensing system for ‘whole system MPs’ in Europe, including models for evidence grading and licensing categories. http://dx.doi.org/10.1016/j.eujim.2012.07.726
109
OP-232 Moringa oleifera (Horseradish tree): tree for life De Monte Teresa International Association Yoga & Ayurveda, Artegna-Udine, Italy Moringa oleifera is known for centuries by developing nations as an important nutritional supplement with a variety of medicinal properties. Unlike other nutritional supplements, Zija provides very low-calorie, quality protein dietary supplementation (containing 19 of the 20 most common amino acids). This study investigates primary food source versus nutritional supplementation, Moringa leaf powder versus malnutrition, as supplementary feeding of human beings. M. oleifera is a chemoprotective, the International Consensus Conference (February 05) affirms: an edible plant-based approach to Helicobacter pylori treatment. In addition, M. oleifera shows the beneficial effect of its ethanolic extract on osteoporosis, considerable promise as a lower-carbohydrate, lower-fat alternative to common liquid dietary supplements and may serve to reverse the effects of many nutrient-depleting prescription and non-prescription drugs. With significant botanical and medical published research in both the academic and the scientific literature, and with substantial ongoing research from the international community, the addition of M. oleifera into the daily diet shows considerable promise as an adjunct to improving health in a variety of important ways. http://dx.doi.org/10.1016/j.eujim.2012.07.727 INTERNATIONAL HEALTH CO-OPERATION OP-233 International cooperation in support of complementary medicine integration in developing countries: the Tuscany–Serbia experience Rossi Elio 1 , Di Stefano Mariella 1 , Baccetti Sonia 2 , Stambolovich Vuk 1,2 1 Ambulatory
of Homeopathy, Local Health Unit of Lucca
2 Fior di Prugna Referring Center for Complementary Medicine
of Tuscany Region, Local Health Unit of Florence, Florence, Italy Objective: The objective of this article is to describe the international health cooperation programmes of the Tuscany Region in Italy supporting the development of complementary, traditional medicine (CTM) in the southern countries of the world. Methods: Projects for decentralised cooperation have been realised in Cuba, Senegal, Serbia and with the Saharawi population of Sahara, with the cooperation of local bodies, international institutions, associations and non-governmental organisations (NGOs). An international seminar on ‘Innovation and Development in the Health System: Inclusion of Complementary and Traditional Medicine in the Public Health System’ was held in Florence in October 2008, with the participation of delegates
110
Oral Presentations / European Journal of Integrative Medicine 4S (2012) 9–123
and experts from 26 countries, NGOs and the agencies of the United Nations. Results: Activities of health cooperation of the Tuscany Region with Cuba were launched in 1994, within the framework of natural and unconventional medicine, and in particular of homeopathic medicine. The veterinary and human homeopathy project with the Saharawi people has been active since 1997. In 2001, acupuncture and traditional Chinese medicine were included in the project ‘Fight against maternal and child mortality’ in Senegal. In 2008, Tuscan Region Referral Centres for Complementary Medicine started the project of international cooperation ‘Support to the Integration of Complementary Medicine in the National and Regional Health System of Serbia’, approved by the Tuscany Region in July 2007 and promoted by the ‘Fior di Prugna’ Centre, in collaboration with the Regional Homeopathy Referral Centre in Lucca, the Serbian Institute of Social Medicine, the University of Belgrade and the ART/UNDP Programme. The aim of the project is to support a strategy of inclusion of complementary medicine in the public health system, to finance a survey on the use of these therapies in the country and to support their inclusion in natural delivery, oncology, assistance to the elderly and palliative treatment. A further aim of this project is the support to physiological delivery at the hospital of Panˇcevo, in the Voivodina Region, which had resulted in mutual missions of doctors and obstetricians to Italy and Serbia. Conclusions: CTM can represent a useful and sustainable resource in different fields of health care. International health cooperation should include programmes supporting the integration of complementary medicine in the public health system in developing countries http://dx.doi.org/10.1016/j.eujim.2012.07.728 OP-234 The global patient’s illness representations as a dialectic referent for interprofessional practice: analysis of the articulation of a plurality of voices and choices in a Canadian integrative health-care clinic Bujold Mathieu Laval University, Quebec, QC, Canada Background: In the past decade, North America has witnessed the emergence of clinics, in which practitioners of different clinical backgrounds (alternative, biomedical) offer integrative health care (IHC) in a spirit of cooperation centred on the whole person. Despite a growing research interest on this kind of organisation, no study has yet analysed in situ the negotiation of viewpoints in the IHC process, taking into account the patient’s illness representations, and even less situating this dynamic in its sociocultural context. Aim: This study aimed to analyse the articulation of a plurality of attitudes in a Canadian integrative health-care clinic. Methods: During a 2-year field study in a Canadian IHC cooperative, grouping together 14 alternative and biomedical practitioners, the therapeutic experiences of 15 chronically ill
patients were examined longitudinally. The objective of this study was to identify and analyse the factors that either foster or impede articulation of viewpoints in an IHC process. The conceptual framework, with its innovative dynamic use of individual explanatory models (iEMs), made it possible to analyse the dynamic interaction between the perceptions of the actors involved in the IHC. Different sources and tools were used in the data collection period in this centre that has been divided into two phases: the first, which we describe as ethnographic, was to accumulate information about the structure of the organisation and operation, using interviews, observations and collections of documents. The second phase consisted of following part of the therapeutic itinerary of patients starting or having recently begun a process of IHC in this centre. A total of 120 h of recording around IHC in this clinic was collected (patient and practitioner interviews, clinical encounters, interprofessional meetings, etc.). Results and discussion: The data analysis shows that the different versions of patient iEM could provide interdisciplinary referents, thus reducing some constraints relating to idiomatical and epistemological diversities. One of the theoretical contributions of this study is that it refines our understanding of the concept of iEM, stressing, among other things, their polymorphic nature. The preconception that the patient has about the practitioner and his practice seems to have a great impact on the way he/she will present his iEM in a clinical encounter. Beyond the fact that it is in keeping with a central postulate of IHC, recognising the importance of the patient’s viewpoints also appears to facilitate the transition from multidisciplinary to interdisciplinary teamwork. http://dx.doi.org/10.1016/j.eujim.2012.07.729 OP-235 Socio-epidemiological research on health behaviour in the Louga Region–Senegal: innovation and scientific tradition towards a better comprehension of the use of health resources Filieri Marcella 1 , Bastiani Luca 2 , Curzio Olivia 2 , Baldini Iside 3 , Traorè Mahamed 4 , Ndeye Edouard Jr 5 , Diakhoumpa Ndongo 6 , Grillo Andrea 7 , Molinaro Sabrina 2 1 Local
Health Unit 5 of Pisa, Pisa, Italy
2 Institute of Clinical Physiology, National Council of Research,
Pisa, Italy 3 Community Development Volunteer Commitment - CISV Turin,
Italy 4 Region Medical Director Louga, Senegal 5 Community Development Volunteer Commitment - CISV Turin, Italy 6 President AMPHOT Louga, Senegal 7 Local Health Care Service 6 Livorno, Italy Background: The World Health Organisation (WHO) recommends that traditional medicine be included in health plans of all countries to improve the strategy for the integration of traditional medicine in modern health-care systems.