““Linking Primary Care with Anthropology and Linking Primary Care with Anthropology and Ethnobotany: The Significance of the Elliniko Ethnobotany: The Significance of the Elliniko Resource Centre for Indigenous Knowledge Resource Centre for Indigenous Knowledge

(ELLRIK) for the University of the Mountains (ELLRIK) for the University of the Mountains in Crete”in Crete”

Workshop: The Development of the University of the Mountains in Crete, Greece - June 2, 2010

Prof. Dr. Christos LionisProfessor of General Practice and Primary

CareHead of the Clinic of Social and Family

MedicineSchool of Medicine, University of Crete

Outline of the presentation

A short guidance on the influential factors that guided the linkage between anthropology and general practice in both education and research

The significance of the indigenous knowledge system and the role of LEAD in developing a global network

A focus on research in medicinal plants A six stages model in developing biosociocultural research New areas of developing research in general practice/family

medicine The OTC SOCIOMED FP7 programme Epilogue

Walking through the narrow street of Walking through the narrow street of research in general practice-Iresearch in general practice-I

http://www.holiday.gr/member/memberphoto.php?PHOTOID=66&TAG_ID=80&lang=gr

Ομ. Καθ. Μιχάλης Φιορέτος/1985 19861986

19881988

19931993

Walking through the narrow street of Walking through the narrow street of research in general practice-IIresearch in general practice-II

1993199319881988

Prof. L.J. SlkkerveerProf. L.J. SlkkerveerProf. Emeritus Erik TrellProf. Emeritus Erik Trell

The significance of Indigenous Knowledge System

ESTABLISHED INDIGENOUS KNOWLEDGE RESOURCE CENTERS

The five areas of use of herbal The five areas of use of herbal medicinemedicine

1. Herbal ailments

2. Herbal treatment as a compensation for inadequate modern therapy

3. Herbs as a complementary to modern medicine treatment

4. Herbs used for common health problems

5. Application for maternal and child care(Le Grand and Wondergem, 1990)

Some evidence from the Some evidence from the anthropological studies in anthropological studies in

primary care in Creteprimary care in CreteSeveral fieldwork training studies were concentrated on Several fieldwork training studies were concentrated on the use of medicinal plants in Crete. They documented:the use of medicinal plants in Crete. They documented:

An indigenous Knowledge Medical System existsAn indigenous Knowledge Medical System exists

Identified several Cretan herbs used as seasoning or Identified several Cretan herbs used as seasoning or infusion for different health and healing purposedinfusion for different health and healing purposed(N. van Beelen 1990, C. van der Hoeven 1992, R. van de Kerk 1993)(N. van Beelen 1990, C. van der Hoeven 1992, R. van de Kerk 1993)

Antioxidant effects of herbs in Crete

(Lionis C, Faresjo A, Skoula M, et al. Lancet 1998)

The antioxidant effect on extracts of ten herbs collected in Crete was studied

The ability of extracts to inhibit lipid peroxidation was assayed in human bronchiole cells

Herb extracts decrease lipid peroxidation in cultured lung cells exposed to iron or ozone

Lipid peroxidation in cells pretreated with a a-tocopherol and then exposed to iron or ozone was almost similar to the decrease observed in cells pretreated with Coridothymus capitatus, Salvia fruticosa and mentha spicata.

Translating knowledge from Medical anthropology into research inGeneral practice:

An example of an effective collaboration among social scientists, rural practitioners and basic sciences

Antioxidant effects of herbs in Crete

Origanum dictamnus (wild)

Origanum dictamnus (cultivated)

Matricaria recutita

Satyreja thymbra

Coridothymus capitatus

Mentha pulegium

Salvia pomifera

Salvia fruticosa

Origanum marjorana

Mentha spicata

The use of local herbs in the traditional Cretan diet: its effect on dyspepsia-I

(Maaike F Palstra, Doctoral thesis, 2003)

Both qualitative and quantitative Both qualitative and quantitative methods.methods.

101 patients were interviewed.101 patients were interviewed.

A household survey (35 subjects were interviewed).A household survey (35 subjects were interviewed).

The use of local herbs in the traditional Cretan diet: its effect on dyspepsia-II

(Maaike F Palstra, Doctoral thesis, 2003)

Dyspepsia was found a frequent health problem (52.5% out Dyspepsia was found a frequent health problem (52.5% out of the patients and 60% out of those in the household survey) of the patients and 60% out of those in the household survey)

17 respondents in the household survey believe that Cretan 17 respondents in the household survey believe that Cretan herbs have a therapeutic effect and 16 out of them drink a herbs have a therapeutic effect and 16 out of them drink a hot herbal teahot herbal tea

Fieldwork training reports and PhD Fieldwork training reports and PhD StudiesStudies

A six stages model for the A six stages model for the biosocio-cultural research in biosocio-cultural research in

primary careprimary care I.I. Making the observationsMaking the observations

II.II. Setting the research idea or questionSetting the research idea or question

III.III. Literature reviewLiterature review

IV.IV. Formulating a hypothesisFormulating a hypothesis

V.V. Looking for anthropological evidenceLooking for anthropological evidence

VI.VI. Testing the biological effect (laboratory or animal Testing the biological effect (laboratory or animal models)models)

(Lionis and Slikkerveer, continuous discussion)

Back to Dioscorides period: Traces of Ancient Greek Medicine in the practices of a Folk-

Healer-I

• Interviewing the lasit surviving bone-setter in the Interviewing the lasit surviving bone-setter in the province of Agios Vassilios, rural Creteprovince of Agios Vassilios, rural Crete

•Basic competencies were fracture restoration and Basic competencies were fracture restoration and medicinal preparation for curing several diseasesmedicinal preparation for curing several diseases

•Roots cutting techniquesRoots cutting techniques

•Use of roots of Arum Maculatum, Cynodon Dactylon, Use of roots of Arum Maculatum, Cynodon Dactylon, Dittricia Viscosa, Junctus Acutus, Nerium Oleander, Dittricia Viscosa, Junctus Acutus, Nerium Oleander, Osyris Alba were reported.Osyris Alba were reported.

(Lionis C, 1998)

Back to Dioscorides period: Traces of Ancient Greek Medicine in the practices of a Folk-Healer-

II

• All these plants used by the modern bone-setter in Agios All these plants used by the modern bone-setter in Agios Vassilios district exist in Dioscorides work.Vassilios district exist in Dioscorides work.

•We recognise the same name that the local people use in We recognise the same name that the local people use in their dialect as the same therapeutic indications and the their dialect as the same therapeutic indications and the same use.same use.

•It remains to be seen, if the ethoparmacological approach It remains to be seen, if the ethoparmacological approach could be contributory to the new drug development in the could be contributory to the new drug development in the near future.near future.

Sense of control and spirituality in rural Sense of control and spirituality in rural CreteCrete

Πληθυσμός 2 κοινοτήτων της Επαρχίας ΒιάννουThe Royal Free Interview for Religious and

Spiritual Beliefs (18 items) (King, et al. Psychol Med 1995) (Sapountzi-Krepia D)The SOC Questionnaire (29 items) (Καράλης, και συν. Αρχεία Ελληνικής Ιατρικής 2004)

Δ. Παπαζήση 2007. Μεταπτυχιακή Εργασία, Πρόγραμμα Μεταπτυχιακών Σπουδών-Δημόσια Υγεία και Διοίκηση Υπηρεσιών Υγείας

A general salutogenetic theory”Sense of coherence”

What creates health and search for "the origin of health" rather

than to look for the causes of disease. Three components in the theory:

ComprehensibilityMeaningfulnessManageability

Measuring the sense of control in rural Measuring the sense of control in rural Crete (Crete (κλίμακα αίσθησης κλίμακα αίσθησης

συνεκτικότητας)συνεκτικότητας)

SCATTERPLOT = SOC Scale Total with Religious SCATTERPLOT = SOC Scale Total with Religious ScaleScale

TOTAL SOC SCORE200180160140120100

religi

ous sc

ore Ba

sed on

q3, q

7, q11

30

25

20

15

10

Η διασύνδεση υπηρεσιών ΠΦΥ και ψυχικής Η διασύνδεση υπηρεσιών ΠΦΥ και ψυχικής υγείας-θέματα προς συζήτησηυγείας-θέματα προς συζήτηση

Ο ρόλος του ιατρού γενικής ιατρικής και των υπηρεσιών των κέντρων υγείας

Ο ρόλος της κοινοτικής νοσηλεύτριας

Οι κοινοτικές δομές και οι υπηρεσίες τους

Η διασύνδεση με τις υπηρεσίες των δήμων και των μη κυβερνητικών οργανισμών

Η ανάπτυξη δικτύων και η ολοκλήρωση (integration) του συστήματος

To νομοθετικό πλαίσιο και η χρηματοδότηση του

OTC SOCIOMED OTC SOCIOMED

“Assessing The Over-The-Counter Medications In Primary Care And Translating The Theory Of Planned Behaviour Into

Interventions”

HEALTH-F2-2009-223654

SEVENTH FRAMEWORK PROGRAMME

Participants Of OTC

SOCIOMED

Project ObjectivesProject Objectives

To create scientific partnerships and develop a practice-based network through research collaboration in order to exchange experiences and make comparisons on public health care issues, such as prescribing and use of medicines;

  To explore beliefs and attitudes, subjective norms and behavioural

control perception in predicting intention to prescribe medicines;  To explore determinants of patients’ health behaviour regarding

prescription of medicines and their rational use;

To develop and implement policy and practice recommendations that will enhance and improve health care systems;

To promote research, especially on the development of national monitoring systems and sustainable nationwide interventions, and on the promotion of rational medicine use at all levels in the health sector. The recommendations of EMEA, on how to administer and use certain medicines for compassionate use, play a significant role in forming the basis of our proposal (EMEA, 2006).

“Mental models are deeply ingrained assumptions, generalizations, or even pictures or images that influence how we understand

the world and how we take action”

• Multivariate model of Tran cultural Health Care Utilisation (Slikkerveer, 1990) •Theory of Planned Behavior (TPB) (Ajzen, 1991)

Theoretical Framework Theoretical Framework

Epilogue

The need to revisit the establishment of ELRIK as an component of the University of Mountains in Crete

A prompt discussion in investing in additional research on ethno botany

A clear need to look for funds in building capacity to implement biomedical research based on the existing IMK in Crete