Mindfulness-based cognitive therapy v. group psychoeducation for people with generalised anxiety disorder: randomised controlled trial

Background: Research suggests that an 8-week mindfulness-based cognitive therapy (MBCT) course may be effective for generalised anxiety disorder (GAD). Aims: To compare changes in anxiety levels among participants with GAD randomly assigned to MBCT, cognitive–behavioural therapy-based psychoeducation and usual care. Method: In total, 182 participants with GAD were recruited (trial registration number: CUHK_CCT00267) and assigned to the three groups and followed for 5 months after baseline assessment with the two intervention groups followed for an additional 6 months. Primary outcomes were anxiety and worry levels. Results: Linear mixed models demonstrated significant group × time interaction (F(4,148) = 5.10, P = 0.001) effects for decreased anxiety for both the intervention groups relative to usual care. Significant group × time interaction effects were observed for worry and depressive symptoms and mental health-related quality of life for the psychoeducation group only. Conclusions: These results suggest that both of the interventions appear to be superior to usual care for the reduction of anxiety symptoms

Toward a Typology of Missionary Medicine: A Comparison of Three Canadian Medical Missions in China before 1937

Until the Communist domination in 1949, medical missionaries had been the chief source of modern health care in China. While there is now a small but growing body of literature on medical missionaries and their work in China, studies in this area have treated missionary medicine as a homogeneous type of health care. This is a simplistic view of missionary medicine, as medical work organized by Christian missions has exhibited a variety of forms in Chinese society. The purpose of this paper is to offer a typology of missionary medicine, which will provide a useful framework for further research in this area. Medical missionary activities fell into three main dimensions, ranging from hospital and dispensary services, or “primary” medical work, to medical education and public health, or “secondary” medical work. While primary medical work was the sine qua non of every mission, the amount of medical resources allocated to secondary medical work varied tremendously among the missions. By using the concepts of “local” and “cosmopolitan,” two types of missionary medicine can be distinguished on the basis of the amount of secondary medical work carried out by a mission. Local medical missions devoted most resources to primary work, making few secondary efforts, whereas cosmopolitan medical missions allocated substantial resources to secondary work apart from maintaining primary work. The medical work of three Canadian missions in China from the turn of the twentieth century to 1937 will be used to illustrate the local-cosmopolitan typology. Also, the utility and implications of the typology for the study of health care in China will be discussed.Ces missions furent, jusqu’à la domination communiste en 1949, les seules sources de soins médicaux modernes en Chine. Bien qu’il existe actuellement une littérature peu importante — mais croissante — sur les missionnaires-médecins en Chine, les études en ce domaine ont traité de la médecine missionnaire en tant que service de santé homogène. Cette opinion sur la médecine missionnaire est simpliste du fait même que le travail médical conduit par les missions chrétiennes a pris des formes diverses dans la société chinoise. L’objectif de l’article qui suit est de présenter une typologie de la médecine missionnaire qui puisse fournir un cadre pour de futures recherches. Les activités médicales des missions comprenaient trois catégories principales, allant du travail à l’hôpital et au dispensaire, ou travail médical « primaire, » à l’enseignement médical et de santé publique, ou travail médical « secondaire. » Alors que le travail médical primaire constituait l’activité sine qua non de chaque mission, l’importance des ressources médicales allouées au travail secondaire variait considérablement selon les missions. L’utilisation des concepts « local » et « cosmopolite » permet de distinguer deux types de médecine missionnaire en fonction de l’importance du travail médical secondaire fourni par la mission. Les missions médicales locales investissaient la plus grande part de leurs ressources dans le travail primaire, délaissant le travail secondaire. Par contre, les missions médicales cosmopolites allouaient d’importantes ressources au travail médical secondaire tout en maintenant le travail primaire. Afin d’illustrer cette typologie local/cosmopolite nous faisons mention du travail médical conduit par trois missions canadiennes en Chine du début du siècle à 1937. Nous discutons aussi de l’utilité et des implications de cette typologie pour la conduite d’études sur les services de santé en Chine

Harvard Medical School of China, 1911-1916: An expanded footnote in the history of western medical education in China

This paper examines some of the more significant issues in western medical education in China, in the early 1900s, by viewing them through the single case of the establishment and dissolution of the Harvard Medical School of China. In particular, this case illustrates some of the fundamental philosophical differences in the way medical missionary educators and the Rockefeller Foundation's China Medical Commission viewed the development of scientific medical education in China.

Missionary doctors vs Chinese patients: Credibility of missionary health care in early twentieth century China

This paper deals with the encounter between the Chinese and Western medical missionaries in early twentieth century China. Based on data of two Canadian Protestant missions in China before 1937, this study reveals that medical missionaries were generally ignorant of Chinese medicine, and they regarded Chinese medicine as part of an inferior, heathen culture. Such a 'mission-centric' perspective prevented the missionary doctors from creating an effective doctor-patient relationship with the Chinese patients. To the Chinese, missionary health care provided an additional health care pathway. The functional complementarity of Western medicine to the pluralistic Chinese medical structure enabled missionary medicine to gain increasing credibility from the Chinese, although few Chinese actually understood the basic principles of Western medicine. Implications of this missionary doctor-Chinese patient relationship in China are discussed.

Gender and HIV risk behavior among intravenous drug users in Sichuan Province, China

Using data from a community-based study of injection drug users (IDUs) in Sichuan Province in China, this study compared the level of HIV risk behavior (needle sharing and unsafe sex) amongst female and male IDUs, and examined the risk factors separately for these two groups. Five risk factors were examined in the analysis, including a lack of family support, having an IDU primary sex partner, economic pressure, lack of access to a methadone program, and younger age. Regression results showed that male and female IDUs had different risk factors. For male IDUs, younger age and a lack of family support increased their level of HIV risk behavior. For female IDUs, having an IDU primary sex partner and economic pressure were predictive of their HIV risk behavior. Sex differences in risk factors are explained with respect to gender norms surrounding HIV risk behavior in the context of social relations. Female IDUs who were sex workers suffered additional HIV risk due to their powerlessness in negotiating safe sex with male customers. Practical implications of the findings for HIV/AIDS prevention and intervention work in China are discussed.HIV/AIDS Injection drug use Gender Risk behavior China

To use or not to use: an update on licit and illicit ketamine use

Jih-Heng Li1, Balasingam Vicknasingam2, Yuet-wah Cheung3, Wang Zhou4, Adhi Wibowo Nurhidayat5, Don C Des Jarlais6, Richard Schottenfeld71College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan; 2National Centre for Drug Research, Universiti Sains Malaysia, Malaysia; 3Department of Sociology, The Chinese University of Hong Kong, Hong Kong, China; 4Wuhan Center for Disease Control and Prevention, Wuhan, China; 5Drug Dependence Hospital RSKO, Jakarta, Indonesia; 6Beth Israel Medical Center, New York, NY; 7School of Psychiatry, Yale University, CT, USAAbstract: Ketamine, a derivative of phencyclidine that was developed in the 1960s, is an anesthetic and analgesic with hallucinogenic effects. In this paper, the pharmacological and toxicological effects of ketamine are briefly reviewed. Ketamine possesses a wide safety margin but such a therapeutic benefit is somewhat offset by its emergence phenomenon (mind-body dissociation and delirium) and hallucinogenic effects. The increasing abuse of ketamine, initially predominantly in recreational scenes to experience a “k-hole” and other hallucinatory effects but more recently also as a drug abused during the workday or at home, has further pushed governments to confine its usage in many countries. Recently, urinary tract dysfunction has been associated with long-term ketamine use. In some long-term ketamine users, such damage can be irreversible and could result in renal failure and dialysis. Although ketamine has not yet been scheduled in the United Nations Conventions, previous studies using different assessment parameters to score the overall harms of drugs indicated that ketamine may cause more harm than some of the United Nations scheduled drugs. Some countries in Southeast and East Asia have reported an escalating situation of ketamine abuse. Dependence, lower urinary tract dysfunction, and sexual impulse or violence were the most notable among the ketamine-associated symptoms in these countries. These results implied that the danger of ketamine may have been underestimated previously. Therefore, the severity levels of the ketamine-associated problems should be scrutinized more carefully and objectively. To prevent ketamine from being improperly used and evolving into an epidemic, a thorough survey on the prevalence and characteristics of illicit ketamine use is imperative so that suitable policy and measures can be taken. On the other hand, recent findings that ketamine could be useful for treating major depressive disorder has given this old drug a new impetus. If ketamine is indeed a remedy for treating depression, more research on the risks and benefits of its clinical use will be indispensable.Keywords: ketamine, psychedelic effects, urinary tract dysfunction, anti-depressant, cognitive impairment, epidemiolog