How primary Chinese health Beliefs and Chinese Culture affect health and Illness?

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Traditional Chinese health beliefs adopt a holistic view emphasizing the significance of environmental factors in increasing risk of disease. Agreeing to Quah (1985), these factors work on the equilibrium of body's harmony, yin and yang. These are two opposite but complementary troops and, together with qi (vital energy), they operate the universe and by comparison the association between citizen and their surroundings. Imbalance in these two forces, or in the qi, results in illness.

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In order to restore the balance, primary restorative practices may be needed. For example, excess `hot' power can be counterbalanced by cooling herbal teas, and vice versa. These beliefs are deeply ingrained among the Chinese, and have been found to be unchanged following migration to Singapore.

Lee, et. Al. (2004), found that patients with exact continuing diseases, namely arthritis, musculoskeletal diseases and stroke, were more likely to use primary Chinese rehabilitation (Tcm). This was strongly considered by the 'chronic disease triad', perceived pleasure with care and cultural health beliefs.

Hence the use of Tcm is not connected with the capability of doctor-patient interaction. Astin (1998) also agreed that it was seen as being more compatible with the patients' values, spiritual and religious philosophy, or beliefs with regard to the nature and meaning of health and illness.

In primary Chinese culture, taking medication is idea to be aversive, hence medications tend to be taken only until symptoms are relieved and then discontinued; if symptoms are not obvious, medications will probably never be taken.

Apart from parental cultural beliefs, minor side effects of sure antibiotics such as stomach upset may lead to the poor adherence of medication. The use of "leftover", "shared" antibiotics and over-the-counter buy of antibiotics by parents are tasteless situations in the community.

They think that their children suffer from the same illnesses judging by the similar symptoms, so they would give the "leftover" or "shared" antibiotics to their children and only bring them to their doctors if there is no correction (Chang & Tang, 2006). This may cause their conditions to deteriorate and may necessitate aggressive treatments later which may have unnecessary side effects.

However, there are small groups of Chinese who also blamed ill-health or misfortunes on supernatural forces, or on divine retribution, or on the malevolence of a 'witch' or 'sorcerer' (Helman, 1994). Such groups will normally seek cures from their religions.

In Singapore, the Ministry of health has drawn up the Tcm Practitioners' Ethical Code and Ethical Guidelines to preclude any unscrupulous practitioners from preying on their patients and taking advantage of their beliefs, for example, molesting ignorant patients.

The degree of acculturation has been evidenced in the following case. An old man was brought into our hospital with a week-long history of malaise, nausea and vomiting, and sudden jaundice. He was diagnosed to have an obstructive mass in the liver.

A biopsy revealed hepatocellular carcinoma. The serological test recommend continuing active hepatitis B. When the news broke to his son that his father had cancer, he requested not to disclose that to his father.

When we discussed end of life issues such as hospice care and "do-not-resuscitate" (Dnr) orders, the son tried to divert the argument to other issues such as when his father could go home.

Cultural Issues that may be complicated in this case are:

The Chinese tend to protect the elderly from bad news.

Believing in karma - the older folk believe that discussing illnesses or death/dying is bad luck. They think that talking about something bad will cause it to come true.

There is an increased incidence of liver cancer resulting from Hepatitis B due to delayed rehabilitation in the elderly, as it may take a long time for them to accept the preliminary diagnosis.

Reference:

Astin Ja. (1998). Why patients use alternative medicine. J Am Med Assoc 1998; 279: 1548-1553.

Chan, G. C. & Tang, S. F. (2006) Parental knowledge, attitudes and antibiotic use for acute upper respiratory tract infection in children attending a primary healthcare clinic in Malaysia. Singapore medical Journal, 47(4):266

Helman, C. G. (1990) Culture, health and Illness. Wright, London.

Quah, S. R. (1985) The health belief Model and preventive health behaviour in Singapore. Social Science and Medicine, 21, 351-363.

Lee Gbw, Charn Tc, Chew Zh and Ng Tp. (2004). Complementary and alternative rehabilitation use in patients with continuing diseases in primary care is connected with perceived capability of care and cultural beliefs. Family Practice, 21(6): 654-660.

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Brain And Neurological Problems Affect Almost Half Of Celiacs Even With A Gluten Free Diet

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Pediatric Physicians - Brain And Neurological Problems Affect Almost Half Of Celiacs Even With A Gluten Free Diet

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There is reasonable evidence of neurological problems in Celiac disease (CD) even those well treated on a gluten-free diet should undergo periodic neurological screening. Peripheral neuropathy is found in almost half of people with CD. Previously, neurological complications in Celiac disease were reported to be as high as 36% or more than a third. Some unexplained neurological problems are present but not recognized by the patient or their doctor in many patients and some have several problems. Unfortunately, since brain imaging is not routinely done or recommended in those who are newly diagnosed we don't really know how high these numbers may be really be. More staggering is the fact that we are still learning about people who fail to meet diagnostic criteria for Celiac disease but are being found to have gluten related neurological problems that respond to a gluten-free diet.

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There are many neurological problems that in undiagnosed and untreated Celiac disease but include neuropathy, balance problems (ataxia), seizures, MS-like symptoms, headaches, memory impairment, depression and anxiety, inattention (ADD/ADHD), schizophrenia, dementia, muscle weakness, childhood developmental delay, autism (Asperger's). The sad truth is that many patients have delays in diagnosis that result in delayed treatment and poor response even while adopting a strict gluten free diet. The average delay of diagnosis in adults is between eleven and thirteen years. Dr. Hadjivassiliou, a neurologist in England who is considered the world's expert in gluten related neurological problems has communicated to me by e-mail and written that responses to a gluten-free diet may take five years and if the neurological condition has been longstanding complete recovery is not likely.

The symptoms of neuropathy are paresthesia (numbness) or dysthesia (burning, tingling, heaviness, "pins and needles" sensation"). Many of my patients also describe hypersensitivity of their skin such that they do not like air blowing on them or their children or spouses against their skin. Some admit to "bug crawling" sensation on their skin, something called vermiculation in medical terms but rarely asked about or given much thought by most doctors. Odd muscle movements under the skin that some call a "bag of worms" medically known as fasiculations are also very common but dismissed by many doctors. My wife, a physician with Celiac disease, actually had these occur while undergoing an EMG (electromyleograph, recording of muscle activity by placing needle electrode into the muscle) exam by an older neurologist. Despite observing these occurring visually and the monitor showing "static like noise" the neurologist dismissed them as "normal".

Many patients with Celiac disease also have what the radiologists and neurologists call "UBO's" on MRI exams of the brain. These unidentified bright objects (think UFO) are white spots that show up on images of the brain. When found in certain locations of the brain they are highly suggestive of multiple sclerosis (multiple scarring spots in the brain). However, though many people with CD have MS like symptoms and these symptoms often respond to a gluten free diet when started early enough, the UBO's seen on MRI of the brain are typically not in the classic areas of MS. Instead it is common to find them in areas of the brain associated with migraines or balance difficulty (ataxia).

Some are seen in children associated with strange seizure problems even without obvious intestinal symptoms. A classic specific syndrome is very well recognized associated with epilepsy in both children and adults who have calcifications in their brain that can be detected by CT scan or MRI. Epilepsy is well documented but the studies are confusing enough that there is not a good consensus regarding the risk and recommended screening of all children with epilepsy.

Personally and professionally I have observed all of the neurological complications of Celiac disease and most of them I have also noted in patients in whom I have not been able to confirm CD but who have what I believe are objective signs and/or genetic risk for gluten sensitivity. I have patients with MS-like symptoms, chronic unexplained neuropathy, headaches, attention difficulties, autistic behaviors and developmental delays who have responded to gluten-free diet but if they had listened to doctors who maintained such a "restrictive, expensive, hard to follow" diet should only be "imposed" on those with a established diagnosis of Celiac disease.

If you have neurological problems get testing for Celiac disease before starting a gluten-free diet. If you test negative for CD, make sure they test you for the complete HLA DQ genetics that includes the high-risk white blood cell patterns DQ2 and DQ8 for Celiac disease AND get blood tests that include IgG and IgA gliadin antibodies. If your blood tests, including gliadin IgA and IgG antibodies, are negative or normal then consider stool testing for gliadin antibodies in the stool (, http://www.enterolab.com).

The evidence continues to accumulate, though often ignored or missed, that gluten is toxic to some people's brains, even if they do not have CD. If you do have Celiac disease it is likely you already have neurological problems and may be at risk despite being on a gluten-free diet. Borrowing from the old advertisement against drug abuse "this is your brain on drugs" maybe we should be getting the word out "this is your brain on gluten". Despite your test results, consider a trial of gluten-free diet after you have your testing done if you have unexplained or unresponsive neurological problems. You owe to your brain. Like my seven-year-old son said to one of our friends, "maybe you should lay off the gluten".

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