knowledge base for transcultural health
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Medals: A Knowledge Base for Transcultural Health and
MedicineDr. Riccardo Colasanti
Rielo Institute for Integral [email protected]
Transcendental Direction and Meaning
Integral Health
Linguistical-Anthropological
CustomsCommunicationHealth LiteracyTraditionalConcept of Life
PsychologicalFearHopeDesireIntention
Clinico-Biological
DiagnosisTheraphyTechnologyInfrastructure
Integral Health
What is Integral health?
1.Communicative competence2.Anthropological competence3.Clinical competence4.Psychological competence
Four competences are defined:
According Van Wieregen et al. (2002) in medical consultation in general practice mutual understanding was poor in 33% of consultations with ethnic-minority patient versus 13% with native-born patientEur J Public Health. 2002 Mar;12(1):63-8.Intercultural communication in general practice.Van Wieringen JC, Harmsen JA, Bruijnzeels MA.
Communication in Transcultural Medicine
The lack of comprehension may imply, medical misdiagnosis (false positive or false negative), erroneous prescriptions, a possible death toll
Outcomes of poor comprehension in medicine
We need to know: Cultural medical models of the patient His cultural expectative How he/she communicates with linguistical
and not-linguistical skills his/her problems How the doctor can communicate to her/him
To improve medical comprehension
According to Tirodkar et al. (2011) …physician’s explanatory models of illness are still largely biomedical in that they emphasize the biological and physical aspects of disease etiology . However, patients or individuals who are experiencing illness may have different explanatory models.
Explanatory models of health and disease among South Asian immigrants in Chicago
Tirodkar,M.A.; Baker,D.W. ; Makoul,G.T.; Khurana,N.; Paracha,M.W.; Kandula,N.R.
J.Immigr Minor.Health., 2011, 13, 2, 385-394, United States
Models of Health and Disease in different cultures
Pre-linguistic Linguistic Cultural (Different Customs in
Food, Habits etc) Philosophical and Religious
(Explanatory Model of Health and Disease, Existential meaning of Life and Disease )
The medical incomprehension is a multilayer issue:
Patient
Sickness
Doctor
Intercultural communication is very complex
objectifying
objectifying
subjectifying
Gesture Ambiguity (ex.: nodding and shaking head) Lack of grammatical precision Hyperbolic use of deictical terms (ex. that, this) that hides the
meaning in case of lack of context Lexical Differences (Ethnoanatomy) False Friends in the Vocabulary The Rethorical use of Medical Language Differences in Conceptual Schemas (Frames di Minsky) Difference in the medical encyclopedia Difference in Health Customs Difference in Symbolic Values Difference in philosophical and religious values
Some tipical issue in Crosscultural Communication in Medicine in
Some examples
The lungs, liver, spleen, and other viscera
ஈரல் : irel
இரத்தக்கவி�ச்சு, (irattacavicciù)
Tamil terms related to health :
Offensive smell of blood.
The anatomical terms define the sameanatomical areas in different languages?
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LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD
No!
Arabic
Bangla-desh
Turkish
Persian
Tamil
Malayalam
Pashto
Sinhala
Manda-rine
Foot Riğl Qadam
Pā Ayak
Pā Kal (more common)
Padam
Kal Kh-pā
Kakula
Jiao
Leg Riğl,Sāq
Pā Bacak(Ayak)
Pā Sāq-e pā (parte inferiore, dal tallone in sù)
Kal Kal Kh-pā KakulaGaataya
Tui
Foot/Leg Diversity in language
(De Blasio, Colasanti 2009)
Foot-Leg
Romanian
Moldovan
LingalaCongo Bandundu
PularGuinea
EweTogo
AmharicEthiopia
Foot Picior Picior,Talpà
Likolo Thépéré
Afo Egher
Leg Picior Picior Likolo Coȉghal Ata Egher
(De Blasio, Colasanti 2009)
Improve health literacy
of patient
e
Improve Culture
al competence of doctor
Patient-Physician Relationship and Racial Disparities in the Quality of Health Care Saha et al. American Journal of Public Health October 2003 Vol 93 n. 10
The reduction of the cultural gap in Health is a two-way path
It is really necessary to constitute a knowledge base of alle the medical observations related to cultural and linguistically topics in all the culture
ion the world
Pub Med (NLM Bethesda) for “cultural diversity” return 10.000 articles
Non medical scientific literature: indetermined number
Google Video looking for “traditional medicine” return 19.700 clips.
Slideshare (presentations) for “traditional medicine ” return 28000 Powerpoint presentation.
+ i social forum, le news etc
Terabyte di data
Basic Problem: Huge Dimension of the Data Base
I we the number of cultural groups is proportional to the number of linguistic differences:
How many cultures in the world?
In the World 2011
Languages Dialects Difference in Grammar
According to Ethnologue(http://www.ethnologue.com/)
6,909 11,779
According Stephen Anderson
~
Secondo World Christian Databasehttp://www.worldchristiandatabase.org
33,000
How many cultures in the world?
Peoples Defined By
Resulting List Examples Totals
Language Linguistic peoples Ethnologue ~7,000
Language / Dialect Linguistic peoples
(Particularly supports language based ministry)
ROPAL (Registry of Peoples and Lang) ~11,000
Language / DialectEthnicity
Ethno-linguistic peoples
(Particularly supports language based evangelistic / discipleship outreaches)
Integrated Strategic Planning Database World Christian Encyclopedia Operation World peoples lists Original Joshua Project list PeopleGroups.org
~ 13,00
0Language / DialectEthnicityReligionCaste Culture
Ethnic peoples
(Particularly supports church planting outreaches)
Joshua Project Registry of Peoples (ROP)
~ 16,60
0Language / DialectEthnicity ReligionCaste CultureEducationPoliticsIdeologyHistorical enmityCustomsBehavior
Unimax peoples
(Particularly supports church planting and all types of evangelistic / discipleship outreaches)
World Christian Encyclopedia estimates US Center for World Mission estimates
~ 27,00
0
Modificato da http://www.joshuaproject.net/how-many-people-groups.php
How many people clusters in the world?
Africa
2,110 =30.5%
Europe
234 =
3.4%
Asia
2,322 =
33.6%Australia& New Zealand1,250 = 18.1%
6,909 Known Living Languages of the World
Americas
993 = 14.4%
http:// www.ethnologue.com/ ethno_docs/ distribution.asp?by=area
Broad Up-to-date Scientific But open to Social Network of Healthcare
Professionals
The Knowledge Base has to be
Taxo
nom
y • Taxonomy• Ontology/based D
ata • Cultural and
Antropologicsl Data
• From scientific literature (Medical and non medical)
• From Social Network
IT • Data Base• Social Network
3 Structural Blocks of the Knowledge Base
1 2 3
Ontologies inMedicine and
Culture (OWL)
Web 2.0 to bepromoted
Web 2.0 alreadyrunning
Non peer-Reviewed
Non Medical(Anthropological or
Etnnological)
MedicalPeer-Reviewed
(PubMed)
KB in Medicineand Culture
Scientifical Data
Data innon-scientific Web
pages
Radio
Literature
Movies
Media
Social Forum
Generic Web pages
Define the taxonomical tree in Medical Anthropology and in Transcultural Medicine
1. Taxonomy Ontology Based
From the scientific literature peer reviewed Medical (Medline) Non Medical
From the social Network of Health Care Professional
2. Cultural Data Collection
A data base to be consulted via web Interface user friendly A IT Social Network platform
3. IT database
3. IT database: Zentity 2.0
This vision for an integrated approach is intended to serve as a catalyst for transforming the health care system to meet the needs of limited-literacy, culturally diverse, and limited English proficiency patients. Clinicians and health care staff have an important role to play, but the responsibility for achieving real progress for patients facing challenges related to literacy, culture, and language must extend to organizations that support them.
Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations
Dennis P Andrulis, Cindy Brach. American Journal of Health Behavior. :
Sep/Oct 2007.
Publish v 0.1
InformationTechnology
Populating KBfrom Literature
Assessment
PrototypingMEDALS
Build Ontologies
Activate SocialNetwork
DefineRequirements
Prototyping
Define a Model ofKB
Test
Prototyping
Connect to KB
Create Platform
Assessment
Categorize withOntologies
Search Non PubMe Journalsd
Search Pub MedJournals
Define Standardsand Procedures
Search Books
Assessment
Create Ontologies
Training HR
Define Procedureof Approval
Define Standard
Number Task Resource Start End Duration%
Complete
2011 2012 2013
September October November December January February March April May June July August September October November December January
1 Define Requirements 1/9/2011 30/9/2011 22
2 Activate Social Network 1/10/2011 31/12/2012 326
2.1 Create Platform 28/4/2012 19/10/2012 125
2.2 Connect to KB 17/10/2012 31/12/2012 54
2.3 Test 27/10/2012 28/12/2012 45
2.4 Prototyping 1/10/2011 8/8/2012 223
3 Build Ontologies 1/10/2011 27/4/2012 150
3.1 Define Standard 1/10/2011 2/11/2011 23
3.2 Define Procedure of Approval 3/11/2011 10/11/2011 6
3.3 Training HR 11/11/2011 23/12/2011 31
3.4 Create Ontologies 24/12/2011 10/2/2012 35
3.5 Assessment 11/2/2012 27/4/2012 55
4 Populating KB from Literature 10/10/2011 28/12/2012 320
4.1 Define Standards and Procedures 10/10/2011 8/12/2011 44
4.2 Search Pub Med Journals 9/12/2011 11/6/2012 132
4.3 Search Non Pub Me Journalsd 9/12/2011 11/6/2012 132
4.4 Search Books 9/12/2011 11/6/2012 132
4.5 Categorize with Ontologies 28/4/2012 26/11/2012 151
4.6 Assessment 27/11/2012 28/12/2012 24
5 Information Technology 1/10/2011 12/7/2012 204
5.1 Define a Model of KB 1/10/2011 12/7/2012 204
5.2 Prototyping 1/10/2011 12/7/2012 204
6 Publish v 0.1 12/6/2012 28/12/2012 144
6.1 Assessment 12/6/2012 28/12/2012 144