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[Tendency, features and cultural background of modern medicine in China].

The new tendency and features of development of medicine in modern China is discussed on the social and cultural background, which bears a dual character of both advancement and backwardness. By analysing the features of modern Chinese civilization, it is emphasized that modern China's medicine was developed on an extremely complex social and cultural background. It was not only restricted within the cultural framework but also governed by the intrinsic rule of medicine itself. This paper also mentions the five features and three tendencies of medicine based on historical facts, which reflects definitely the objective rules of modern Chinese medicine. It is these rules that links premodern and modern medicine. The work of contemporary China is in line with these rules.

China↗

Changes in mandibular morphology from the Jomon to modern periods in eastern Japan.

Metric characteristics of the mandibles of modern and various historical populations from the Kanto region (east-central Japan) were compared with those of their possible ancestral populations, i.e., the Jomon population from Kanto and the Yayoi population from northern Kyushu and Yamaguchi (western Japan). The Jomon people were aboriginal Holocene inhabitants of Japan, while the Yoyoi skeletal series are considered to largely represent immigrants from the Asian continent. Compared to the presumed ancestral morphology, the mandibles of the modern and pre-modern peoples of Kanto showed a marked narrowing, as well as reduction in the regions of major masticatory muscle attachments. The main cause of this underdevelopment is likely to be a diminished chewing stress, resulting in insufficient stimulation for proper growth of the jaw bone. In contrast, symphyseal height increased compared to the earlier Kanto populations. This may be a reflection of the existence of significant Yayoi genetic contribution in the formation of the modern and pre-modern Kanto populations. On the other hand, the mandibles of the protohistoric to medieval populations of the Kanto region are morphologically closer to Jomon. Therefore, they seem to have been genealogically continuous from the native Jomon people with some degree of gene flow stemming from the immigrants.

Adult↗

A modern human humerus from the early aurignacian of Vogelherdhöhle (Stetten, Germany).

Implicit in much of the discussion of the cultural and population biological dynamics of modern human origins in Europe is the assumption that the Aurignacian, from its very start, was made by fully modern humans. The veracity of this assumption has been challenged in recent years by the association of Neandertal skeletal remains with a possibly Aurignacian assemblage at Vindija Cave (Croatia) and the association of Neandertals with distinctly Upper Paleolithic (but non-Aurignacian) assemblages at Arcy-sur-Cure and St. C¿esaire (France). Ideally we need human fossil material that can be confidently assigned to the early Aurignacian to resolve this issue, yet in reality there is a paucity of well-provenanced human fossils from early Upper Paleolithic contexts. One specimen, a right humerus from the site of Vogelherd (Germany), has been argued, based on its size, robusticity, and muscularity, to possibly represent a Neandertal in an Aurignacian context. The morphological affinities of the Vogelherd humerus were explored by univariate and multivariate comparisons of humeral epiphyseal and diaphyseal shape and strength measures relative to humeri of Neandertals and Early Upper Paleolithic (later Aurignacian and Gravettian) modern humans. On the basis of diaphyseal cross-sectional geometry, deltoid tuberosity morphology, and distal epiphyseal morphology, the specimen falls clearly and consistently with European early modern humans and not with Neandertals. Along with the other Vogelherd human remains, the Vogelherd humerus represents an unequivocal association between the Aurignacian and modern human morphology in Europe.

Animals↗

Colonial modern skeletal change in the U.S.A.

Eighty-two people dating from 1975 to 1879 compared with 182 modern middle-class White and Black skeletons test the myths of radical changes produced by improved diet, less disease, and nineteenth century immigration. Longevity increases and health and growth improvement is clearest in reduced juvenile deaths (census data) and deepening of true pelvis. Stature increase is minimal (though seventeenth century Londoners and modern West Africans are shorter than Colonial to Modern Americans); teeth deteriorate and for cultural reasons fractures increase. Clavicles and forearms elongate. From Old to New World Colonial samples there is a noticeable skull change (and a greater Old World to Modern contrast) but White Colonial to Modern shows strong continuity surprisingly, the key changes being increasing head height, and retraction of face with increasing nose projection, and longer mastoids, resulting from selection and mixture. Blacks change more, possibly from Indian and White mixture. Variabilities are above average. Change is much less than expected, and apparently involves heterosis and selection as well as the obvious health advance and mixtures.

Adolescent↗

Modern human origins in Australasia: replacement or evolution?

The controversies surrounding the origins of modern humans have spawned two competing hypotheses, namely Replacement and Multiregional Evolution. The first suggests that modern Homo sapiens evolved first in Africa, as late as 140 ka, and subsequently inhabited the balance of the Old World. Conversely, the second hypothesis posits that modern humans evolved principally from local populations of archaic hominids indigenous to the major regions of the Old World. The hominid mandibular remains (ca. 1 Ma) from Sangiran, central Java, Indonesia, were studied in order to test these hypotheses. Non-metric comparisons were performed between these fossils and aboriginal H. sapiens from Africa and Australia. The Replacement model would be supported by a unique Afro-Australian grouping while Multiregional Evolution would be suggested by a Sangiran-Australasian group which would exclude the modern Africans. These data support the Multiregional Evolution hypothesis in that a plurality (eight) of the seventeen non-metric features link Sangiran to modern Australians, while only three exclusively group the humans from Africa and Australia. These results are suggestive of morphological continuity, which implies the presence of a genetic continuum in Australasia dating back at least one million years.

Animals↗

Epidemiology of tardive dyskinesia: is risk declining with modern antipsychotics?

Second-generation antipsychotic drugs (APDs), including aripiprazole, clozapine, olanzapine, risperidone, quetiapine, and ziprasidone dominate outpatient and inpatient clinical practice, having largely displaced the older neuroleptics. Modern APDs have relatively low risk for acute extrapyramidal syndromes characteristic of older neuroleptics, particularly acute dystonia and Parkinsonism, with variable risks of akathisia and the rare neuroleptic malignant syndrome. Anticipated reduction in risk of tardive dyskinesia (TD) is less well documented. Nearly 50 years after initial reports on TD, it is appropriate to reexamine the epidemiology of this potentially severe late adverse effect of long-term APD treatment in light of current research and practice. We compared recent estimates of incidence and prevalence of TD identified with some modern APDs to the epidemiology of TD in the earlier neuroleptic era. Such comparisons are confounded by complex modern APD regimens, uncommon exposure limited to a single modern APD, effects of previous exposure to typical neuroleptics, and neurological assessments that are rarely prospective or systematic. Available evidence suggests that the risk of TD may be declining, but longitudinal studies of patients never treated with traditional neuroleptics and exposed to only a single modern APD are required to quantify TD risks with specific drugs. Long-term use of APDs should continue to be based on research-supported indications, with regular specific examination for emerging TD.

Age Factors↗

Late Pleistocene human population bottlenecks, volcanic winter, and differentiation of modern humans.

The "Weak Garden of Eden" model for the origin and dispersal of modern humans (Harpending et al., 1993) posits that modern humans spread into separate regions from a restricted source, around 100 ka (thousand years ago), then passed through population bottlenecks. Around 50 ka, dramatic growth occurred within dispersed populations that were genetically isolated from each other. Population growth began earliest in Africa and later in Eurasia and is hypothesized to have been caused by the invention and spread of a more efficient Later Stone Age/Upper Paleolithic technology, which developed in equatorial Africa. Climatic and geological evidence suggest an alternative hypothesis for Late Pleistocene population bottlenecks and releases. The last glacial period was preceded by one thousand years of the coldest temperatures of the Later Pleistocene (approximately 71-70 ka), apparently caused by the eruption of Toba, Sumatra. Toba was the largest known explosive eruption of the Quaternary. Toba's volcanic winter could have decimated most modern human populations, especially outside of isolated tropical refugia. Release from the bottleneck could have occurred either at the end of this hypercold phase, or 10,000 years later, at the transition from cold oxygen isotope stage 4 to warmer stage 3. The largest populations surviving through the bottleneck should have been found in the largest tropical refugia, and thus in equatorial Africa. High genetic diversity in modern Africans may thus reflect a less severe bottleneck rather than earlier population growth. Volcanic winter may have reduced populations to levels low enough for founder effects, genetic drift and local adaptations to produce rapid population differentiation. If Toba caused the bottlenecks, then modern human races may have differentiated abruptly, only 70 thousand years ago.

Animals↗

The multiregional and single origin hypotheses of the evolution of modern man: a reconciliation.

A current debate opposes two theories of the origin of modern man. One view is that modern Homo sapiens emerged from Africa relatively recently, most probably within the last two or three hundred thousand years (Wilson & Cann, 1992, Sci. Am. 266(4), 22-27). The opposing view is that modern man has resulted from parallel evolution in different regions, producing convergent modernization of local populations over the last million years or so--the multiregional model (Frayer et al., 1993, Am. Anthrop. 95, 14-50). Proponents of both views believe that their interpretations are irreconcilable. The object of the present paper is to describe a genetic mechanism--mitochondrial exclusion--which offers a basis for a model of human evolution that is compatible with the evidence adduced for both contemporary views. The model proposes a mechanism by which complete replacement of archaic mitochondrial DNA may have occurred in a population produced by recent admixture of archaic and modern types of man.

Animals↗

Depression and modernization: a cross-cultural study of women.

BACKGROUND: This study concerns depression among women living in developing and developed parts of the world. Using a continuum of environments conceptualized as ranging from traditional to modern, the goal is to explore the hypothesis that the prevalence of depression will be higher among those living in modern compared to traditional societies. This issue is examined among samples from West Africa and North America. METHODS: The subjects are 657 women who reside in four locations. An operational definition of modernization is used to place the locales as a continuum in the following order: rural Yorubaland in Nigeria, Yorubas living in urban Nigeria, rural Canada, and urban United States. Variables employed include education, religious orientation, and the role of women as mothers and workers. Depression is assessed using an algorithm based on generally acknowledged criteria. Multivariate logistic regression is used to generate point estimates and confidence intervals for prevalence odds ratios, to adjust for potential confounders, and to assess effect modification. RESULTS: The prevalence of depression was lowest among rural Nigerians and highest among urban residents in the United States. The association of depression with the proposed continuum was strongest among women under the age of 45 who had living children (Odds Ratio: 2.1; 95% Confidence Interval: 1.6-2.9). CONCLUSIONS: In the areas studied, a traditional way of life seems to offer protection against some of the stresses associated with modernization although it does not appear to compensate for the adversity of childlessness. Level of modernization may be a useful concept for understanding differences in rates of depression in different parts of the world.

Canada↗

The impact of economic progress and modernization in medicine on the ossification of hand and wrist.

One of the main criteria used for age estimations of young living subjects is the developmental status of the ossification of hand bones. The impact of economic progress and modernization in medicine on ossification rates in a given population still requires further clarification. We selected 36 samples from literature for which the ossification status had been determined with the Greulich-Pyle method and analyzed specific economic data (per capita income) and demographic data (life expectancy at birth) as parameters of modernization. To describe the influence of these parameters on the rate of ossification, we performed a regression analysis and found that a relatively high level of economic progress and modernization in medicine coincides with high ossification rates, while relatively low modernization seems to delay ossification. When performing age estimations, the expert opinion should therefore pay attention to the issue of different modernization levels.

Age Determination by Skeleton↗

God's laboratory: religious rationalities and modernity in Ecuadorian in vitro fertilization.

Catholicism is the only major world religion that unequivocally bans the use of in vitro fertilization (IVF). Nevertheless, in Ecuador, Catholic IVF practitioners declare God's dominion over their IVF laboratories and clinics in explaining pregnancy outcomes. My analysis of this routine combination of spiritual and material causal models in Ecuadorian IVF contributes to two ongoing discussions about (1) the tensions between "institutional" and popular forms of Catholic religiosity and (2) the proper boundaries of science in modernity. The Catholic Church's historical and contemporary struggle to determine control of the miraculous has usually been characterized as a conflict between educated clergy and humble peasants. In the case of Ecuadorian IVF, we find, instead, educated elites and middle classes participating in this same contestation with the Church, proclaiming their direct ability to harness the power of God to effect material change on earth. This spiritual power to affect clinical outcomes does not take place just anywhere, but in clinic and lab, disrupting another set of presumptions about modern scientific practice and subjectivity. Like other Ecuadorian elites and middle classes, IVF practitioners are heirs to Enlightenment thought, and experience themselves as modern in their participation in these high-tech endeavors. But their spiritual approach to laboratory rationality does not trouble these IVF practitioners' experience of themselves as moderns, prompting a reevaluation of the narratives of scientific modernity that limit their scope to Europe and North America.

Attitude to Health↗

Traditional and modern medicine in South Africa: a research study.

This paper examines the relationship between traditional and modern medicine with reference to an experimental research study conducted in South Africa, which focused on interviews by traditional Zulu healers and modern clinical psychologists with the same group of psychiatric patients. Results indicated that while traditional and modern practitioners worked from different theoretical orientations, they were in significant agreement as to both diagnosis and treatment of patients when faced with the same limited choice of options. Furthermore, patients perceived both traditional and modern practitioners as being more or less equally helpful. Results are compared with those of other studies. Local and international implications for the relationship between traditional and modern medicine are discussed.

Humans↗

Active patients: the integration of modern and traditional obstetric practices in Nepal.

This paper describes the integration of modern and traditional obstetric practices in a provincial hospital in the Maithili-speaking area of southern Nepal. The doctors and nurses consciously distance themselves from the traditional practices of their obstetrical patients, whom they view as 'ignorant'; but because hospital resources are insufficient to impose the normative form of modern medical organization, patients and their relatives assert a more active role in providing hospital-based care. In consequence, mothers are delivered according to both modern, clinical as well as local cultural practices. Recent WHO policy has cast modern medicine as the agent in the integration of traditional healing within national health systems. This essay shows that in poor countries the powers of agency may not be exclusively in the hands of the medical profession. Patients, and others in their social networks, have become agents, constraining and negotiating the terms on which modern medicine is to be integrated within their traditional obstetric practices.

Attitude of Health Personnel↗

Comparison of inverse-dynamics musculo-skeletal models of AL 288-1 Australopithecus afarensis and KNM-WT 15000 Homo ergaster to modern humans, with implications for the evolution of bipedalism.

Size and proportions of the postcranial skeleton differ markedly between Australopithecus afarensis and Homo ergaster, and between the latter and modern Homo sapiens. This study uses computer simulations of gait in models derived from the best-known skeletons of these species (AL 288-1, Australopithecus afarensis, 3.18 million year ago) and KNM-WT 15000 (Homo ergaster, 1.5-1.8 million year ago) compared to models of adult human males and females, to estimate the required muscle power during bipedal walking, and to compare this with those in modern humans. Skeletal measurements were carried out on a cast of KNM-WT 15000, but for AL 288-1 were taken from the literature. Muscle attachments were applied to the models based on their position relative to the bone in modern humans. Joint motions and moments from experiments on human walking were input into the models to calculate muscle stress and power. The models were tested in erect walking and 'bent-hip bent-knee' gait. Calculated muscle forces were verified against EMG activity phases from experimental data, with reference to reasonable activation/force delays. Calculated muscle powers are reasonably comparable to experimentally derived metabolic values from the literature, given likely values for muscle efficiency. The results show that: 1) if evaluated by the power expenditure per unit of mass (W/kg) in walking, AL 288-1 and KNM-WT 15000 would need similar power to modern humans; however, 2) with distance-specific parameters as the criteria, AL 288-1 would require to expend relatively more muscle power (W/kg.m(-1)) in comparison to modern humans. The results imply that in the evolution of bipedalism, body proportions, for example those of KNM-WT 15000, may have evolved to obtain an effective application of muscle power to bipedal walking over a long distance, or at high speed.

Adult↗

Retrospective evaluation of surgical endodontic treatment: traditional versus modern technique.

The aim of this retrospective study was to compare the outcome of surgical endodontic treatment preformed using the traditional versus modern techniques. There were 110 patients who were treated by surgical endodontic treatment between 2000 and 2002 and evaluated from their dental charts. The surgical endodontic treatment was preformed using a traditional or modern technique. The traditional technique included root-end resection with a 45 degrees bevel angle, and retrograde preparation using a carbide round bur. The modern technique included root-end resection with minimal or no bevel, and retrograde preparation using ultrasonic retro-tips with the aid of a dental operating microscope. The retrograde filling material for both techniques was intermediate restorative material. There were 71 patients with 88 treated teeth that were compatible with the inclusion criteria. Complete healing rate for the teeth treated with the modern technique (91.1%) was significantly higher than that for teeth treated using the traditional technique (44.2%) (p < 0.0001). In the traditional technique a significant (p = 0.032) negative influence of the tooth type was found. Modern surgical endodontic treatment using operative microscope and ultrasonic tips significantly improves the outcome of the therapy compared to the traditional technique.

Adolescent↗

The modern mental health system in Nepal: organizational persistence in the absence of legitimating myths.

This paper advances an organizational explanation for the slow pace of modernization of mental health care systems in developing societies. In complement to cultural and political economic explanations of this condition, we suggest that the value of establishing modern systems in developing societies lies in the legitimation such structures provide for indigenous modernizing efforts vis-a-vis both indigenous and external audiences. The system need not meet actual levels of service demand. Its importance is in its symbolic value as an indicator of modernity. The result is a system in "permanent failure". Implications for institutional theory and the growth of modern mental health systems in developing societies are discussed.

Community Mental Health Services↗

Preferential occurrence of diazotrophic endophytes, Azoarcus spp., in wild rice species and land races of Oryza sativa in comparison with modern races.

Several diazotrophic species of Azoarcus spp. occur as endophytes in the pioneer plant Kallar grass. The purpose of this study was to screen Asian wild rice and cultivated Oryza sativa varieties for natural association with these endophytes. Populations of culturable diazotrophs in surface-sterilized roots were characterized by 16S rDNA sequence analysis, and Azoarcus species were identified by genomic fingerprints. A. indigens and Azoarcus sp. group C were detected only rarely, whereas Azoarcus sp. group D occurred frequently in samples of flooded plants: in 75% of wild rice, 80% of land races of O. sativa from Nepal and 33% of modern cultivars from Nepal and Italy. The putatively endophytic populations of diazotrophs differed with the rice genotype. The diversity of cultured diazotrophs was significantly lower in wild rice species than in modern cultivars. In Oryza officinalis (from Nepal) and O. minuta (from the Philippines), Azoarcus sp. group D were the predominant diazotrophic putative endophytes in roots. In contrast, their number was significantly lower in modern cultivars of O. sativa, whereas numbers and diversity of other diazotrophs, such as Azospirillum spp., Klebsiella sp., Sphingomonas paucimobilis, Burkholderia sp. and Azorhizobium caulinodans, were increased. In land races of O. sativa, the diazotrophic diversity was equally high; however, Azoarcus sp. was found in high apparent numbers. Similar differences in populations were also observed in a culture-independent approach comparing a wild rice (O. officinalis) and a modern-type O. sativa plant: in clone libraries of root-associated nitrogenase (nifH) gene fragments, the diazotrophic diversity was lower in the wild rice species. New lineages of nifH genes were detected, e.g. one deeply branching cluster within the anf (iron) nitrogenases. Our studies demonstrate that the natural host range of Azoarcus spp. extends to rice, wild rice species and old varieties being preferred over modern cultivars.

Asia↗

Marrying modern health practices and technology with traditional practices: issues for the African continent.

One of the main sessions at the 2001 22nd Quadrennial Congress of the International Council of Nurses in Denmark explored the harnessing of modern health technologies for contemporary health care. The session theme of 'marrying the old and the new' is particularly important in societies where modern medicine and technology coexist with traditional approaches to health care; in this instance, its coexistence with traditional medicine in African societies. This coexistence has not been easy for many African countries. For some, overt exclusion from health care systems through prohibitive legislation has become the order of the day for traditional practitioners. On the other hand, there has been an increasing interest in traditional practices among modern health practitioners and a willingness to collaborate. Similarly, traditional practitioners are slowly beginning to incorporate aspects of modern medicine into their practice; notably the use of science and technology. This report describes the interface of modern medicine and technologies with traditional approaches to health care. Benefits and concerns raised by genetic, information, solar and environmental technologies at this interface, are discussed. Selected traditions and the challenges these bring to the practice arena, research, education and policy, are presented together with suggestions to reconcile old and new.

Africa↗