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

1. “Linking Primary Care with Anthropology and Ethnobotany: The Significance of the Elliniko Resource Centre for Indigenous Knowledge (ELLRIK) for the University of the Mountains in Crete” Workshop: The Development of the University of the Mountains in Crete, Greece- June 2, 2010 Prof. Dr. Christos Lionis Professor of General Practice and Primary Care Head of the Clinic of Social and Family Medicine School of Medicine, University of Crete

2. 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

3. Walking through the narrow street of research in general practice-I Ομ. Καθ. Μιχάλης Φιορέτος/1985 1986 1988 http://www.holiday.gr/member/memberphoto.php?PHOTOID=66&TAG_ID=80&lang=gr 1993

4. Walking through the narrow street of research in general practice-II 1988 1993 Prof. L.J. Slkkerveer Prof. Emeritus Erik Trell

5. The significance of Indigenous Knowledge System

6. ESTABLISHED INDIGENOUS KNOWLEDGE RESOURCE CENTERS

7. The five areas of use of herbal medicine • Herbal ailments • 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)

8. Some evidence from the anthropological studies in primary care in Crete • Several fieldwork training studies were concentrated on the use of medicinal plants in Crete. They documented: • An indigenous Knowledge Medical System exists • Identified several Cretan herbs used as seasoning or infusion for different health and healing purposed (N. van Beelen 1990, C. van der Hoeven 1992, R. van de Kerk 1993)

10. Antioxidant effects of herbs in Crete • 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. (Lionis C, Faresjo A, Skoula M, et al. Lancet 1998)

11. Translating knowledge from Medical anthropology into research in General practice: An example of an effective collaboration among social scientists, rural practitioners and basic sciences

12. 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

13. The use of local herbs in the traditional Cretan diet: its effect on dyspepsia-I • Both qualitative and quantitative methods. • 101 patients were interviewed. • A household survey (35 subjects were interviewed). (Maaike F Palstra, Doctoral thesis, 2003)

14. The use of local herbs in the traditional Cretan diet: its effect on dyspepsia-II • Dyspepsia was found a frequent health problem (52.5% out of the patients and 60% out of those in the household survey) • 17 respondents in the household survey believe that Cretan herbs have a therapeutic effect and 16 out of them drink a hot herbal tea (Maaike F Palstra, Doctoral thesis, 2003)

15. Fieldwork training reports and PhD Studies

16. A six stages model for the biosocio-cultural research in primary care • Making the observations • Setting the research idea or question • Literature review • Formulating a hypothesis • Looking for anthropological evidence • Testing the biological effect (laboratory or animal models) • (Lionis and Slikkerveer, continuous discussion)

18. 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 province of Agios Vassilios, rural Crete • Basic competencies were fracture restoration and medicinal preparation for curing several diseases • Roots cutting techniques • Use of roots of Arum Maculatum, Cynodon Dactylon, Dittricia Viscosa, Junctus Acutus, Nerium Oleander, Osyris Alba were reported. (Lionis C, 1998)

19. 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 Vassilios district exist in Dioscorides work. • We recognise the same name that the local people use in their dialect as the same therapeutic indications and the same use. • It remains to be seen, if the ethoparmacological approach could be contributory to the new drug development in the near future.

20. Sense of control and spirituality in rural Crete • Πληθυσμός 2 κοινοτήτων της Επαρχίας Βιάννου • The 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

21. Measuring the sense of control in rural Crete (κλίμακα αίσθησης συνεκτικότητας) 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: Comprehensibility Meaningfulness Manageability

22. 30 25 20 religious score Based on q3, q7, q11 15 10 100 120 140 160 180 200 TOTAL SOC SCORE SCATTERPLOT = SOC Scale Total with Religious Scale

23. 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 Η διασύνδεση υπηρεσιών ΠΦΥ και ψυχικής υγείας-θέματα προς συζήτηση

24. 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

25. Participants Of OTC SOCIOMED

26. Project 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).

27. Theoretical Framework “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)

28. 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