Traditional Health Care Services Research Articles

Exploring the lived experiences of women with infertility using traditional healthcare services in Harare urban, Zimbabwe.

Infertility has a significant impact on the lives of women. Therefore, affected women often consider the treatment options available to deal with their condition, including traditional healthcare services (THS). The aim of this phenomenological study was to explore the lived experiences of women with infertility problems who sought help from traditional health practitioners in Harare, Zimbabwe. Data from interviews with five women with infertility was explicated using a simplified version of Hycner (1985) five step explication process. Two major themes and eight sub themes emerged from the findings. The major themes were traditional diagnosis experiences and traditional treatment experiences. Consultation and divination were the diagnosis methods experienced by the women with infertility. The THS offered comprehensive management of infertility through couples therapy, as well as pre- and post-natal therapies, which include lifestyle counselling. The findings also showed that women with infertility commonly receive concurrent treatment, including both allopathic and traditional medicine. This presents an opportunity to explore the convergence of traditional and allopathic approaches in the management of infertility in women.

Psychological, sociocultural, and coping experiences of women with infertility using traditional healthcare services in Harare urban, Zimbabwe: A qualitative study.

This study focused on the psychological, social, and cultural dimensions of infertility among women with infertility in Harare Urban who have utilised traditional healthcare systems to address their infertility problem. It also emphasises their coping strategies for dealing with the challenges encountered along the infertile journey. This was a qualitative study using a phenomenological approach, focusing on the experiences of five women. Data from the interviews was analysed using a simplified version of Hycner's (1985) five-step explication process. The study produced three main themes: psychological experiences, socio-cultural experiences, and coping experiences, along with seven sub-themes. The results showed that women experienced intense distress, sorrow, and self-blame because of their inability to have children, further compounded by the stigma they faced from their families and communities. Women with infertility are subjected to derogatory labels, social contempt, ridicule, and being undervalued, which leads them to develop coping strategies to endure the adverse encounters. These coping mechanisms can have either positive or negative effects on their overall welfare. The exploration of psychological, socio-cultural factors, and coping mechanisms of women with infertility problems' presents a chance to co-create interventions that empower them.

The Feasibility and Efficacy of Warrior Health and Fitness: A 3-Month Fitness and Nutrition Program for Veterans.

Veterans are at risk for mental and physical health problems but may not seek traditional health care services. Wellness-based interventions, including exercise and nutrition, have been associated with improvements in physical and mental health among this population. This study explores the acceptability, feasibility, and efficacy of a 3-month health and fitness program for veterans. Participants in 2 time-based cohorts from 2019 to 2023 (cohort 1: n = 261; cohort 2: n = 256) were cleared by a physician to participate. Participants then completed a fitness test and self-reported surveys (e.g., quality of life, sleep, and pain) before and after the 3-month program. Participants were recruited to participate at one of three sites: Boston, MA Fort Myers, FL, or Tampa, FL. The 3-month program consisted of weekly, supervised group fitness and one-on-one sessions, nutritional consultations, yoga, and other wellness activities. Primary program outcomes were measured by fitness assessments, self-report surveys, program completion, and program satisfaction. Fitness assessments included measures of weight, body mass index, grip strength, waist to hip ratio, body fat, lean mass, fat mass, heart rate, and blood pressure (BP). Self-report measures included quality of life, depression, loneliness, sleep quality, pain intensity, and pain interference. In cohort 1, significant improvements were found for measures of weight (P = .01), left-handed grip strength (P < .01), body fat percent (P < .01), and quality of life (P < .01). In cohort 2, significant improvements were found for measures of waist:hip ratio (P = .02), right and left-handed grip strength (P < .01), body mass index (P = .02), body fat percent (P < .01), and quality of life (P = .02). For both cohorts, pain intensity (cohort 1: P = .01, cohort 2: P < .001) and pain interference (cohort 1: P = .02, cohort 2: P < .001) increased significantly. These data suggest that a 3-month health and fitness program for veterans is acceptable and feasible and may improve physical and mental health outcomes. Considerations for program retention and assessment completion are discussed.

"There's always something, and then there's more": a qualitative examination of how virtual peer led self-management can create community around the evolving SCI experience.

Self-management programs for spinal cord injury (SCI) are a growing adjunct to traditional healthcare services aiding individuals with SCI in learning and managing symptoms and medical care. A benefit of self-management programs is that they can be facilitated by peers, offering a unique lived experience of adjusting to and managing SCI. While a growing body of literature highlights the effectiveness of peer led programs, there is limited understanding of how individuals engage with peer programs or critical components of peer support. The current study seeks to understand how individuals engaged with peers in the context of a self-management program. Secondary qualitative analysis of online forum posts resultant from a peer led self-management course for SCI. Content analysis revealed several themes of how participants engaged with members of the group, including skill building, resource sharing, and problem solving. A process level theme of emotional connection to others living with similar SCI-related challenges was defined as "bearing witness." Participants commented frequently that groups were the first time they engaged with a community with lived experience, and shared experience was frequently highlighted in the responses from individuals as one of the most unique and important aspects of the intervention. Themes identified suggest that bearing witness was a critical component of peer led intervention. While self-management content provided structure for engagement and discussion, participants report that connectedness and shared experience made content more impactful and relevant. Future research should examine if alignment of peer and participant experience increases the impact of interventions and explore if this theme is important for other chronic medical populations.

DIGITAL HEALTH TOOLS FOR BREASTFEEDING MOTHERS: A COMPARATIVE REVIEW BETWEEN NIGERIA AND THE US

This comparative review evaluates and compares the impact and adoption of mobile apps and digital platforms, including Babyroo, in supporting breastfeeding mothers in Nigeria and the US. Breastfeeding is crucial for infant health and development, yet many mothers face challenges and require support. Digital health tools, such as mobile apps and online platforms, offer a promising solution to provide information, guidance, and support to breastfeeding mothers. Nigeria and the US were chosen for comparison due to their different healthcare systems, cultural norms, and levels of technological adoption. The review examines the features, accessibility, and effectiveness of digital health tools, particularly Babyroo, in supporting breastfeeding mothers in both countries. The findings reveal that digital health tools play a significant role in supporting breastfeeding mothers in both Nigeria and the US. Babyroo, in particular, offers a range of features such as breastfeeding tips, tracking tools, and online communities for mothers to connect and share experiences. However, the adoption of these tools varies between the two countries. In Nigeria, where access to healthcare services is limited, digital health tools like Babyroo can bridge the gap and provide essential support to breastfeeding mothers. In contrast, in the US, where healthcare services are more accessible, digital health tools serve as a supplement to traditional healthcare services, offering convenience and additional resources for breastfeeding mothers. Overall, the review highlights the potential of digital health tools, such as Babyroo, in supporting breastfeeding mothers globally. However, it also emphasizes the importance of context-specific approaches and the need for further research to understand the impact and effectiveness of these tools in different cultural and healthcare settings.&#x0D; Keywords: Digital Health, Tools, Breastfeeding, Mothers, Comparative.

Telemedicine in diabetic eye care: A meta-analysis of its effectiveness in underserved populations

Telemedicine has emerged as a promising tool in diabetic eye care, particularly for underserved populations facing barriers to accessing traditional healthcare services. This meta-analysis aims to evaluate the effectiveness of telemedicine interventions in managing diabetic eye conditions within underserved communities. Through a systematic review of existing literature, encompassing diverse telemedicine approaches such as remote screening, teleconsultation, and telemonitoring. These studies were conducted across various regions with underserved populations, including rural areas, low-income urban neighborhoods, and underserved ethnic groups. The meta-analysis revealed significant improvements in several key outcome measures. Firstly, telemedicine interventions led to increased rates of early detection of diabetic retinopathy and other diabetic eye complications, facilitating timely intervention and preventing progression to more severe stages of the disease. Secondly, telemedicine facilitated better access to specialist care, overcoming geographical barriers and reducing the burden of travel for patients. Thirdly, telemedicine interventions were associated with improved patient compliance with follow-up appointments and treatment regimens, leading to better long-term management of diabetic eye conditions. Moreover, subgroup analyses revealed that telemedicine was particularly effective in reaching vulnerable populations such as elderly individuals, those with limited mobility, and ethnic minorities, thereby addressing disparities in healthcare access. Telemedicine holds great promise as an effective tool for diabetic eye care in underserved populations, offering a scalable and cost-effective approach to improving access to timely screening, diagnosis, and management of diabetic eye conditions. Further research and implementation efforts are warranted to optimize telemedicine interventions and ensure equitable access to quality eye care for all.

Secure Sharing of Electronic Medical Records Based on Blockchain

As network technology advances and more people use devices, data storage has become a significant challenge due to the explosive growth of information and the threat of data leaks. In traditional medical institutions, most medical data is stored centrally through cloud computing technology in the institution’s data center. This centralized storage method has many security risks, and once the central server is attacked, it will lead to the loss of medical data, which will lead to the leakage of patients’ private data. At the same time, electronic medical records are the most critical data in the current medical field. In the traditional centralized healthcare service system (HSS), there are data leakage problems and tampering with electronic medical records due to human factors. At the same time, each hospital is built independently, resulting in the current centralized healthcare service system having a data silo problem, making it difficult to share medical data between institutions securely. With the increase in the number of users in the system, the electronic medical record data in the system also increases gradually, resulting in the increasing overhead of decryption calculation. Therefore, this paper proposes a blockchain-based access control scheme with multiparty authorization to ensure the security of electronic medical records. The scheme uses an SM encryption algorithm to encrypt the medical data in the system. It adds the patient’s signature to ensure the confidentiality and security of the data, and the encrypted electronic medical records (EMRs) are stored in the InterPlanetary File System (IPFS) to realize the distributed storage of EMR. In addition, role-based multiauthorization access control is implemented through smart contract-based to ensure the security of EMR. We have analyzed the security of this paper’s solution and compared its performance with the existing schemes based on other cryptographic algorithms. The experimental results show that the proposed solution significantly improves the secure sharing of EMR and provides system performance.

"It has to be better, otherwise we will get stuck." A Review of Novel Directions for Mental Health Reform and Introducing Pilot Work in the Netherlands.

The current state of mental health care in the Netherlands faces challenges such as fragmentation, inequality, inaccessibility, and a narrow specialist focus on individual diagnosis and symptom reduction. A review suggests that in order to address these challenges, an integrated public health approach to mental health care that encompasses the broader social, cultural, and existential context of mental distress is required. A Mental Health Ecosystem social trial seeks to pilot such an approach in the Netherlands, focusing on empowering patients and promoting collaboration among various healthcare providers, social care organizations, and peer-support community organizations, working together in a regional ecosystem of care and committed to a set of shared values. In the ecosystem, mental health problems are examined through the prism of mental variation in context whilst scaling up the capacity of group-based treatment and introducing a flexible and modular approach of (2nd order) treatment by specialists across the ecosystem. The approach is to empower naturally available resources in the community beyond professionally run care facilities. Digital platforms such as psychosenet.nl and proud2bme.nl, which complement traditional mental health care services and enhance public mental health, will be expanded. The capacity of recovery colleges will be increased, forming a national network covering the entire country. GEM will be evaluated using a population-based approach, encompassing a broad range of small-area indicators related to mental health care consumption, social predictors, and clinical outcomes. The success of GEM relies heavily on bottom-up development backed by stakeholder involvement, including insurers and policy-making institutions, and cocreation. By embracing a social trial and leveraging digital platforms, the Dutch mental health care system can overcome challenges and provide more equitable, accessible, and high-quality care to individuals.

Long-Term Efficacy of primary care combining a mobile healthcare application with human coaching

Abstract Background Chronic diseases have become a global burden, and digital self-healthcare using mobile devices has gained importance in managing these conditions. However, barriers to implementing mobile self-management healthcare applications in current primary care system, and previous research has focused on short-term effects. This study aims to evaluate the long-lasting effect of combining human coaching with mobile self-management healthcare applications for chronic disease patients in primary healthcare services. Methods The study recruited 178 patients with chronic diseases from participating primary care clinics. The intervention group (N = 128) received a 12-week mobile self-management healthcare application service combined with traditional primary care, while the control group (N = 50) received only traditional healthcare. The Noom application was used, with two weekly human coaching sessions by a nutritionist. A telephone survey on weight changes was conducted one year after the intervention. Results The intervention group showed a greater weight loss compared to the control group during the intervention period (Intervention: -1.29 ± 2.94 vs Control: -0.38 ± 1.72, P-value 0.002). Although there was no statistically significant difference in additional weight change between the two groups during the follow-up period, the difference in weight loss during the intervention period was maintained (Intervention: -2.16 ± 5.54 vs Control: -1.06 ± 3.24, P-value: 0.008). Additionally, among the intervention group continuously for 1 year using the health management application, the average weight loss was higher than the other groups. Conclusions Combining a mobile self-management healthcare application with human coaching has long-lasting effects and can be effective in primary healthcare services. This suggests that such an approach has the potential to be a treatment option in current primary healthcare systems, but further large-scale long-term studies are needed. Key messages • This study suggests that using mobile self-management healthcare apps with human coaching can be an effective long-term treatment option for chronic disease patients in primary healthcare services. • The combination of the two methods may provide better outcomes than traditional healthcare services alone.

Peer-delivered point-of-care testing and linkage to treatment for hepatitis C virus infection among marginalized populations through a mobile clinic in Copenhagen, Denmark

BackgroundGlobally, many people with hepatitis C virus (HCV) infection are marginalized and have very limited access to traditional healthcare services, including HCV testing and treatment. Models of care attuned to the needs of the marginalized population at risk are needed. This study aimed to evaluate the testing and treatment uptake of a community-based, peer-led model of care offering point-of-care testing. MethodsIn this interventional cohort study, people at risk of HCV infection were recruited between May 2019 and December 2021 at a community-based, peer-led mobile clinic. During a single visit, participants were offered a point-of-care HCV antibody test, and, if antibodies were detected, an additional RNA test. Participants with detectable HCV RNA were linked with peer-assisted referral to a ‘fast-track’ clinic at a major hospital. The primary outcomes were the number of people engaged in testing and the proportion who initiated treatment and achieved a sustained virologic response (SVR). ResultsWe tested 728 individuals. Of those, 208 (29%) were positive for HCV antibodies, and 114 (15%) were HCV RNA detectable. Of the 114, 80 (70%) initiated treatment, and 79 (99%) achieved SVR. The main reason for not initiating treatment was non-Danish citizenship with no legal access to health care. ConclusionThis study found that a peer-led point-of-care service is a model of care that can engage marginalized groups in HCV testing and linkage to treatment.

Efficiency, quality, and management practices in multidisciplinary and traditional diabetes healthcare services in Mexico

AbstractDiabetes is a major health issue in middle-income countries like Mexico. Multidisciplinary healthcare (MHC) models aim to improve diabetes care and reduce costs. However, the relationship between management practices, efficiency, and quality of care in MHC and traditional healthcare (THC) models is unclear. This study evaluates the efficiency and quality of diabetes healthcare models in Mexico, identifying associated management practices. Methodology. Data from a retrospective longitudinal analysis were used to compare 20 THC and 20 MHC. Technical efficiency (TE) scores were estimated using data envelopment analysis (DEA), quality scores were calculated based on provider competence and patient performance. The relationship between efficiency, quality, and management practices was analyzed using positive deviance regression. Results. DEA analysis indicate higher TE in MHC units (mean score: 65, SD = 19) compared to THC units (mean score: 24, SD = 23). MHC units scored 78.55 (SD = 18.71) in performance score, while THC units scored 37.7 (SD = 18.97). MHC units also outperformed THC units in competence scores (mean: 68.71, SD = 18.31 vs. 49.97, SD = 23.31). Several management practices were associated with best performance in terms of both efficiency and quality strategic thinking, human resource management, financial management, operations management, performance management, and governance. Conclusion. This study highlights the higher efficiency of MHC models in diabetes care compared to THC models in Mexico. However, both models require improvement in quality. Understanding the relationship between management practices, efficiency, and quality can guide policymakers in enhancing diabetes care in low- and middle-income countries.

Smart healthcare sensor with dual autonomous self-healing, repeatable skin adhesion/detachment, and hydrophilic/hydrophobic Janus surface for aquatic ambulatory electrophysiological monitoring

Smart healthcare sensors (SHSs) belong to a kind of patient-centered diagnostics, which highly revolutionizes traditional healthcare service and attracts great attention. However, widespread application of currently-reported SHSs is severely limited due to their non-ideal mechanical/electrical self-healing performance, too robust/weak skin-adhesion strength, and poor water resistance. A kind of novel film-based SHSs that composed of poly(3-hexylthiophene-2, 5-diyl)/butyl rubber (P3HT/BR), eutectic Gallium-Indium (E-GaIn), and polydimethylsiloxane-P3HT/BR (P-P3HT/BR) were proposed herein and employed for high-performance electrocardiogram (ECG) monitoring. Specifically, viscosity characteristic and low glass transition temperature of BR, hooked chains of P3HT, and encapsulated E-GaIn jointly endowed the SHSs with high mechanical and electrical self-healing efficiencies of 79.62% ± 5.60% and 94.49% ± 5.05%, respectively. Meanwhile, skin adhesion mechanism of the SHSs was mainly relied on Van der Waals force and friction force, thus resulting in a sufficient adhesion or painless detachment with a skin-adhesion strength of 7.00 ± 0.70 kPa. More interestingly, extensive experimental results performed in pigs and humans demonstrated the SHSs achieved ECG monitoring with high accuracy and stable sensitivity underwater, due to the designed hydrophilic/hydrophobic Janus surface. Overall, the as-fabricated SHSs provided an outstanding biopotential monitoring and paved an ascendant way toward personalized healthcare in the new era.

Acceptability of integrating traditional tuberculosis care with modern healthcare services in the Amhara Regional State of Northwest Ethiopia: A qualitative study

Many people with tuberculosis (TB) rely solely on traditional healthcare services. Integrating traditional healthcare with modern healthcare services can increase access, quality, continuity, consumer satisfaction, and efficiency. However, successful integration of traditional healthcare with modern healthcare services requires stakeholder acceptance. Therefore, this study aimed to explore the acceptability of integrating traditional care with modern TB care in the South Gondar zone, the Amhara Regional State, northwest Ethiopia.Data were collected from patients with TB, traditional healers, religious leaders, healthcare providers, and TB program personnel. Data were collected using in-depth interviews and focus group discussions from January to May 2022.A total of 44 participants were included in the study. The context and perspectives of integration were thematized into the following five major themes: 1) referral linkage, 2) collaboration in awareness creation in the community, 3) collaboration in monitoring and evaluation of integration, 4) maintaining continuity of care and support, and 5) knowledge and skill transfer. Integrating traditional and modern TB care was acceptable to both modern and traditional healthcare providers as well as TB service users. This may be an effective strategy for improving the TB case detection rate by decreasing diagnosis delay, treatment initiation, and catastrophic costs.

Perspectives on Music Healing by Traditional Healers and Music Therapists

Abstract The majority of South Africans use both traditional and Western healthcare services. Although traditional healers have long since recognized and utilized the healing power of music, music therapy as a profession in this country is largely aligned with Western medical approaches, as it is regulated by the Health Professions Council of South Africa. This alignment leaves little recognition to traditional health practitioners. In the current study, we explored music therapists’ and traditional healers’ perceptions of their roles and relationships with each other in South African healthcare with the hope of initiating dialogue. Four traditional healers (TH) and four music therapists (MT) participated in interviews within this multiple case study, and thematic analysis was used to interpret the data. We identified eight overarching themes that appeared most salient to the music therapists and traditional healers (framed from their perspectives): (1) Both our practices support wellbeing, with music as a tool; (2) We both seek to enhance general well-being, but with different specializations; (3) We both focus on relational connection; (4) We both emphasize the importance of culture; (5) THs emphasize spirituality; (6) We hold curious, yet cautious regard for each other’s practices; (7) MT may aid in addressing psychosocial needs in South Africa; and (8) We both welcome a pluralism of approaches. Both groups of practitioners envisioned a future healthcare system that embraces multiple modalities while reflecting on the need to engage in issues related to boundaries of scopes of practice. They highlighted the need for greater trust between practitioners from different approaches to serve a diverse population better.

Development, reliability and validity of sense of gain scale for traditional Chinese medicine healthcare services for older adults in the community

The Chinese government values the older adults' sense of gain from healthcare service. The aim of this study was to construct a Sense of Gain Scale for traditional Chinese medicine (TCM) healthcare services for older adults in the community, and evaluate its reliability and validity. Based on literature review and expert consultation, this study developed a Sense of Gain Scale for TCM healthcare services for older adults in the community. A total of 460 participants were recruited to perform reliability analysis, exploratory factor analysis, and Spearman correlation analysis, while another 673 participants were used for confirmatory factor analysis to evaluate the validity of the scale. The Sense of Gain Scale was composed of 14 items that could be classified into the following five dimensions: satisfaction, effectiveness, accessibility, fairness, and responsiveness. The overall Cronbach's α coefficient of the scale was 0.961, with each dimension ranging from 0.861 to 0.928. The split-half reliability of the total scale was 0.971, indicating good reliability. Five common factors were extracted to explain 85.49% of the total variation. exploratory factor analysis showed that the scale had good construct validity. Satisfaction with Life Scale (SWLS) was used to evaluate criterion validity, and the correlation coefficient between test score and criterion was > 0.6. The Sense of Gain Scale has good reliability and validity, and can be used as a measurement tool to evaluate the level of sense of gain for TCM healthcare services for older adults in the community.

Focusing on the multi-disciplinary treatment and integrative nursing model, inheriting and innovating characteristic external therapy of Traditional Chinese Medicine, and constructing a new system for Traditional Chinese Medicine healthcare services

Focusing on the multi-disciplinary treatment and integrative nursing model, inheriting and innovating characteristic external therapy of Traditional Chinese Medicine, and constructing a new system for Traditional Chinese Medicine healthcare services

The Impact of an Electronic Portal on Patient Encounters in Primary Care: Interrupted Time-Series Analysis.

Electronic patient portals are online applications that allow patients access to their own health information, a form of asynchronous virtual care. The long-term impact of portals on the use of traditional primary care services is unclear, but it is an important question at this juncture, when portals are being incorporated into many primary care practices. We sought to investigate how an electronic patient portal affected the use of traditional, synchronous primary care services over a much longer time period than any existing studies and to assess the impact of portal messaging on clinicians' workload. We conducted a propensity-score-matched, open-cohort, interrupted time-series evaluation of a primary care portal from its implementation in 2010. We extracted information from the electronic medical record regarding age, sex, education, income, family health team enrollment, diagnoses at index date, and number of medications prescribed in the previous year. We also extracted the annual number of encounters for up to 8 years before and after the index date and provider time spent on secure messaging through the portal. A total of 7247 eligible portal patients and 7647 eligible potential controls were identified, with 3696 patients matched one to one. We found that portal registration was associated with an increase in the number of certain traditional encounters over the time period surrounding portal registration. Following the index year, there was a significant jump in annual number of visits to physicians in the portal arm (0.42 more visits/year vs control, P<.001) but not for visits to nurse practitioners and physician assistants. The annual number of calls to the practice triage nurses also showed a greater increase in the portal arm compared to the control arm after the index year (an additional 0.10 calls, P=.006). The average provider time spent on portal-related work was 5.7 minutes per patient per year. We found that portal registration was associated with a subsequent increase in the number of some traditional encounters and an increase in clerical workload for providers. Portals have enormous potential to truly engage patients as partners in their own health care, but their impact on use of traditional health care services and clerical burden must also be considered when they are incorporated into primary care.

Security aspects related Intelligent e-Health Systems

Current health situations and crises require physicians and researchers to convert traditional healthcare services to a new generation of digital healthcare known as e-health smart systems that operate close to the end user with the objective to provide medical assistance using advanced technologies including Internet of Medical Things technology, edge computing, and cloud computing paradigms. However, this system architecture reveals limitations in terms of latency, bandwidth, power consumption as well as security and privacy of collected data. Through this paper, a presentation of different healthcare monitoring system layers has been defined, in addition to listed challenges faced by the deployment of this technology, while providing an introduction of security risks that threaten the user data safety alongside the e-health layers. Moreover, a summarized discussion of Blockchain technology came over to provide a secure decentralized architecture in sharing data across allowed entities.

Privacy conserving authenticated key settlement approach for remote users in IoT based Telecare Medicine information system

The Fourth Healthcare Industrial Revolution is transforming the traditional healthcare service to Internet of Things (IoT) based smart healthcare system. Telecare medicine information system (TMIS) is one of them which demands 100% electronic transaction. In this situation, User authentication, fortifies the legitimate patients, doctors, medical helper staffs, etc. Not only that, but it also allows them to access the remote medical servers to serve medical services. Robust and Efficient user authentication plays a vital role here. Many researchers proposed different techniques, but all of them have different limitations like computational expenses, huge memory usage, excessive communication overhead, etc. In this article, a very lightweight authentication approach of remote user is demonstrated in IoT based smart healthcare environment. This approach optimizes the use of one-way hash function, exclusive-or operation and extended One-Time-Password which make the authentication approach lighter and effective. The security strength of the recommended protocol is elaborated with the help of informal and formal security analysis. Well known BAN logic and Real-Or-Random (ROR) model are used in to check the correctness of the protocol and ensure the security of the established session key. In addition to that, AVISPA (automated validation of Internet security protocols and applications) and ProVerif software simulation tools are utilized which parade, the proposed protocol is safe and secure against many attacks like Man-In-The-Middle attack and Replay attack, Ephemeral secret leakage attack, Known-session-specific-temporary-information attack, Impersonation attack, etc. and maintain the secrecy of the session key. Furthermore, the recommended protocol is compared with the existing/recently published protocols to exhibit better performance.

Prevailing traditional health care services in Western Ladakh, Indian Trans-Himalaya

Background: There has been a spurt in revival of Traditional Health Care Services (THCS) in different parts of the world due to increasing awareness about their importance and the initiatives taken by the local governments. Ladakh, located in the Indian Trans-Himalaya represents an ethno-cultural landscape with well-established history of use of traditional medicines in healing of different ailments. However, several THCS so far remained informal and have not been documented properly. The present study aimed to assess and document the status of three different THCS viz., Amchis, Akhons and Shamans in western Ladakh. Methods: Both qualitative and quantitative data about the 36 Amchis, 53 Akhons and 21 Shamans was collected through questionnaire surveys, semi-structured interviews and participatory appraisals in three valleys of western Ladakh were organized. Results: The Amchis and Akhons were mostly middle aged and older men while Shamans were mostly young women. All the three healers were generally illiterate with weak socio-economic status. Amchis and Akhons were more experienced as it was their main profession and received the knowledge hereditary. Amchis and Shamans were mostly Buddhist while Akhons were Muslim. These traditional healers treated 17 different ailments. Conclusion: The local population of the western Ladakh reported that most of the sub-centers and primary health centers lack medical equipment, drugs, and skilled workforce. Due to deficiencies in health care services the use of indigenous healthcare practices is common. Efforts should be made to fortify THCS by collaborating with modern medicine systems to improved local health care. Of all the THCS, the Amchi system or Sowa-rigpa seems to be the most codified and might therefore be the most logical one to be integrated into the public health care system. Keywords: Traditional health care system, Amchi, Akhon, Shaman, Western Ladakh