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Schiele JK, Jeitler M, Michalsen A, Stapelfeldt E, Ortiz M, Sigl M, Brinkhaus B, Wischnewsky M, Kessler CS. Wellness or medicine? Use and perception of Ayurveda in Germany: data from an online-representative cross-sectional study. Front Med (Lausanne) 2024; 11:1408609. [PMID: 38841569 PMCID: PMC11150709 DOI: 10.3389/fmed.2024.1408609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/26/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Ayurveda, South Asia's largest and most relevant system of Traditional Medicine, holds a legal status akin to conventional Western medicine in India and elsewhere. There is an almost complete lack of data on the use of Ayurveda in Germany. The aim of this study was to investigate Ayurveda's utilization patterns, entry points, and factors influencing its use and the perception of Ayurveda among the German population. Methods Basis of this manuscript was an online-representative survey which involved 4,065 participants aged 18-75 about the use and acceptance of Traditional, Complementary and Integrative Medicine (TCIM) in Germany. The survey was conducted online using Computer Assisted Web Interview (CAWI) in 2022. The dataset was analyzed descriptively and inferentially. Results Altogether 9.3% (n = 377) of all survey participants (n = 4,065) had already used Ayurveda somehow, either more often (1.7%) or at least once in a lifetime (7.6%). Responders associated Ayurveda primarily with Indian Medicine (27.7%) and wellness (18%). Commonly used Ayurvedic services included non-medical treatments at wellness resorts/spas (48.3%), in outpatient practices (27.1%), and hotels (23.6%). 30.2% of the participants believe in Ayurveda's therapeutic potential. 76.7% of Ayurveda users find healthy nutrition important or very important. Nine predictors were found to classify Ayurveda users vs. non-users with spirituality and belief in Ayurveda's therapeutic efficacy as the most relevant ones. Ayurveda seems to be primarily used by well-educated and female individuals, often from higher-income groups and with a rather modern social milieu-orientation. Conclusion Study results suggest that about every tenth German citizen has used Ayurveda in the past and about one third believes in its therapeutic potential. Because Ayurvedic therapies are often not evidence-based, there is an urgent need to perform high quality randomized controlled trials to investigate potential effects and safety of Ayurveda and how evidence-based Ayurveda treatments can be integrated into the German healthcare system.
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Affiliation(s)
- Julia K. Schiele
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Nature-Based Therapies, Immanuel Hospital Berlin, Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Nature-Based Therapies, Immanuel Hospital Berlin, Berlin, Germany
| | - Elmar Stapelfeldt
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Nature-Based Therapies, Immanuel Hospital Berlin, Berlin, Germany
| | - Miriam Ortiz
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mike Sigl
- Institute for Cultural Studies, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Benno Brinkhaus
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Manfred Wischnewsky
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Mathematics and Computer Science, University Bremen, Bremen, Germany
| | - Christian S. Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal and Nature-Based Therapies, Immanuel Hospital Berlin, Berlin, Germany
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Mozumdar A, Das BM, Kundu Chowdhury T, Roy SK. Utilisation of public healthcare services by an indigenous group: a mixed-method study among Santals of West Bengal, India. J Biosoc Sci 2024; 56:518-541. [PMID: 38385266 DOI: 10.1017/s0021932024000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
A barrier to meeting the goal of universal health coverage in India is the inequality in utilisation of health services between indigenous and non-indigenous people. This study aimed to explore the determinants of utilisation, or non-utilisation, of public healthcare services among the Santals, an indigenous community living in West Bengal, India. The study holistically explored the utilisation of public healthcare facilities using a framework that conceptualised service coverage to be dependent on a set of determinants - viz. the nature and severity of the ailment, availability, accessibility (geographical and financial), and acceptability of the healthcare options and decision-making around these further depends on background characteristics of the individual or their family/household. This cross-sectional study adopts ethnographic approach for detailed insight into the issue and interviewed 422 adult members of Santals living in both rural (Bankura) and urban (Howrah) areas of West Bengal for demographic, socio-economic characteristics and healthcare utilisation behaviour using pre-tested data collection schedule. The findings revealed that utilisation of the public healthcare facilities was low, especially in urban areas. Residence in urban areas, being female, having higher education, engaging in salaried occupation and having availability of private allopathic and homoeopathic doctors in the locality had higher odds of not utilising public healthcare services. Issues like misbehaviour from the health personnel, unavailability of medicine, poor quality of care, and high patient load were reported as the major reasons for non-utilisation of public health services. The finding highlights the importance of improving the availability and quality of care of healthcare services for marginalised populations because these communities live in geographically isolated places and have low affordability of private healthcare. The health programme needs to address these issues to improve the utilisation and reduce the inequality in healthcare utilisation, which would be beneficial for all segments of Indian population.
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Affiliation(s)
| | - Bhubon Mohan Das
- Department of Anthropology, Haldia Government College, Purba Medinipur, West Bengal, India
| | | | - Subrata K Roy
- Biological Anthropology Unit, Indian Statistical Institute, Kolkata, India
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Thangavelu PD, Janakiraman B, Pawar R, Shingare PH, Bhosale S, Souza RD, Duarte I, Nunes R. Understanding, being, and doing of bioethics; a state-level cross-sectional study of knowledge, attitude, and practice among healthcare professionals. BMC Med Ethics 2024; 25:30. [PMID: 38500167 PMCID: PMC10949768 DOI: 10.1186/s12910-024-01028-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The field of bioethics examines the moral and ethical dilemmas that arise in the biological sciences, healthcare, and medical practices. There has been a rise in medical negligence cases, complaints against healthcare workers, and public dissatisfaction with healthcare professionals, according to reports from the Indian Medical Council and other healthcare associations. We intend to assess the level of knowledge, attitude, and practice of bioethics among the registered healthcare professionals (HCPs) of Maharashtra, India. METHODS A State-level online survey was conducted among the registered HCPs (n = 2143) casing all five regions of the Maharashtra state using a pre-tested self-administered questionnaire. The responses were expressed as mean, and proportions with their standard deviation and 95% CI respectively. Binary logistic regression and a multivariate logistic model were used to determine factors associated with knowledge, attitude, and practice of bioethics. RESULTS Of the 2143 registered HCPs in Maharashtra included in this study, most of them (65.2%) had adequate knowledge of bioethics. Adequate knowledge was associated with lower age, profession (nurses and dentists), employment in the private sector, HCPS at Marathwada and Pune, and higher educational attainment. About 3 in 5 HCPs (59.4%) had a favorable attitude towards the ethical practice of bioethics, and was associated with profession, place of work, region of practice, and work experience. The distribution of unethical bioethics practices among 10 items was proportionally high, and only 34.4% reported good/fair practice. The common unethical practices in the state were allowing patients to be examined by interns, and not informing them about professional misconduct to the regulatory bodies. CONCLUSION Most HCPs had adequate knowledge of bioethics, which is encouraging and would favor the laying foundation for forming a good bioethics framework. Only 3/5 HCPs demonstrated a favorable attitude, and the observed unethical practice is alarmingly common. A serious consideration to evaluate the compliance level of bioethics practice periodically and measures to educate, sensitize, and train bioethics among HCPs in Maharashtra is warranted.
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Affiliation(s)
- Poovishnu Devi Thangavelu
- Center of Bioethics, Faculty of Medicine, University of Porto, Porto, Portugal.
- Krishna College of Physiotherapy, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, 415539, India.
- International Chair in Bioethics, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, 415539, India.
| | - Balamurugan Janakiraman
- SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology (SRMIST), Kattankulathur, Tamil Nadu, 603203, India
| | - Renuka Pawar
- International Chair in Bioethics, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, 415539, India
- School of Dental Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, 415539, India
| | - Pravin H Shingare
- Pro Chancellor, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, 415539, India
| | - Suresh Bhosale
- Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, 415539, India
| | - Russel D Souza
- International Institute of Organizational Psychological Medicine, Melbourne, Australia
| | - Ivone Duarte
- Center of Bioethics, Faculty of Medicine, University of Porto, Porto, Portugal
- Center of Bioethics, Faculty of Medicine, and MEDCIDS - Department of Community Medicine, Information and Decision in Health; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Nunes
- Center of Bioethics, Faculty of Medicine, University of Porto, Porto, Portugal
- Center of Bioethics, Faculty of Medicine, and MEDCIDS - Department of Community Medicine, Information and Decision in Health; Faculty of Medicine, University of Porto, Porto, Portugal
- Center of Bioethics, Faculty of Medicine, University of Porto, Porto, Portugal
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Rao VS, Armour M, Cheema BS, Smith CA, Moran L, Perera RS, Lim S, Gupta S, De Manincor M, Vaidya R, Ee C. Use of traditional and complementary medicine by ethnic Indian women living with polycystic ovary syndrome: a global survey. BMC Complement Med Ther 2023; 23:392. [PMID: 37924068 PMCID: PMC10623873 DOI: 10.1186/s12906-023-04229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/20/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Traditional, complementary, and integrative medicine (TCIM) is commonly used by those living with Polycystic Ovary Syndrome (PCOS) but little is known about the use of TCIM such as yoga and Ayurveda in ethnic Indian women with PCOS living worldwide. This survey aimed to explore the prevalence and types of TCIM used and in particular the pattern of use of yoga and Ayurveda including reasons for not using and future interest in using them among non-users. METHOD An online, international cross-sectional survey was conducted using a pre-designed survey tool. Participants were ethnic Indian women of reproductive age who reported that they were medically diagnosed with PCOS. Descriptive analysis was used to identify the proportion of TCIM users, while a multivariable binary logistic regression was used to analyze their characteristics. RESULTS Data from 3130 respondents were analysed. The prevalence of TCIM use was 80% (2515/3130). Yoga and Ayurveda were the most frequently practised TCIM modalities with a prevalence of 57% and 37% respectively. We found a high future interest in using yoga (81%) and Ayurveda (70%) among the non-users. The motivation for most Ayurveda use was a recommendation from family/friends (66%), rather than personal choice (38%) or the internet (19%). Most women used Ayurveda because it has natural ingredients (64%) and it is safe (60%) and cited its use to be safe and somewhat helpful. The majority of women were currently practising yoga (73%) up to four times a week (54%) at home (93%). Yoga was primarily used to improve overall health (67%), manage weight (64%), stress (54%) hormonal imbalance (49%) and emotional well-being (48%). Barriers to practising yoga were common among the current users and non-users and included lack of motivation (59% and 59%), time constraints (48% and 39%), and non-availability of yoga teachers specialised in PCOS (31% and 23%). Most women found yoga to be helpful and preferred individual one-on-one (52%) yoga sessions specifically tailored for PCOS (58%). CONCLUSION This is the first international study that discovered the prevalence and pattern of TCIM use among ethnic Indian women with PCOS living worldwide. We support the urgent need for more research, education, and regulation of different TCIM modalities to promote safe and effective practices globally.
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Affiliation(s)
- Vibhuti Samarth Rao
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, 2571, Australia.
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, 2571, Australia
| | - Birinder S Cheema
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Caroline A Smith
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, 2571, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, 3168, Australia
| | - Romain S Perera
- Department of Cell and Developmental Biology, University College London, London, WC1E 6BT, UK
| | - Siew Lim
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Boxhill, VIC, 3128, Australia
| | - Sabrina Gupta
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3689, Australia
| | - Michael De Manincor
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, 2571, Australia
| | - Rama Vaidya
- Division of Endocrine and Metabolic Disorders, Kasturba Health Society's Medical Research Centre, Mumbai, 400056, India
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, 2571, Australia.
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Garg CC, Goyanka R. Unit costs for allopathic and AYUSH outpatient care in public facilities in Urban Delhi, India. J Family Med Prim Care 2023; 12:2752-2756. [PMID: 38186811 PMCID: PMC10771190 DOI: 10.4103/jfmpc.jfmpc_2289_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/05/2023] [Accepted: 04/18/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction The National Health Policy, 2017, suggests pluralism in health care with the integrated delivery of AYUSH and allopathic care at public facilities. Information on unit cost of outpatient visits for both types of care at public facilities is useful to guide the policies on health-care delivery. Methods The costs in 2019-20 were estimated for each type of care at allopathic urban primary health center (UPHC) and AYUSH facilities using top-down methodology and adding out-of-pocket expenditures (OOPE) incurred to reflect true costs. Data from national health survey, annual government budgets, and reports were used. Results The average cost of an outpatient visit for allopathic care was ₹325 at a UPHC and ₹189 in a homeopathic dispensary and ₹692 in an Ayurvedic dispensary. While OOPE per visit at UPHC was ₹177, no OOPE was incurred at AYUSH facilities. The government expenditure per visit for allopathic care at UPHC at ₹148 was the lowest compared to any type of AYUSH care. The cost per facility for allopathic UPHC was higher than both Ayurvedic and homeopathic dispensaries. Unani dispensaries were least cost-effective, both in terms of cost per visit and cost per facility. Conclusion Costs per visit at a facility are impacted by footfalls. For Ayurveda, despite lower facility costs as compared to UPHC, per visit costs were higher due to low utilization. Improving evidence-based utilization of AYUSH care is critical for the success of the government policy of mainstreaming AYUSH care at low cost.
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Affiliation(s)
- Charu C. Garg
- Health and Nutrition-Research Programme, Institute for Human Development, New Delhi, India
- Syzygy Consulting, LLC, CA, USA
| | - Roopali Goyanka
- Department of Economics, Indraprastha College for Women, University of Delhi, Delhi, India
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Patwardhan B. Where lies the future of Ayurveda-inspired drug discovery? Expert Opin Drug Discov 2023; 18:947-949. [PMID: 37345376 DOI: 10.1080/17460441.2023.2228201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/19/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Bhushan Patwardhan
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
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Zadey S. Yes to pluralistic health system, but no to homeopathy. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 10:100172. [PMID: 37383360 PMCID: PMC10305988 DOI: 10.1016/j.lansea.2023.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/10/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Siddhesh Zadey
- Corresponding author. 215, Bajaj Nagar, Nagpur, Maharashtra 440010, India.
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