Neuropharmacological effects of Nigerian honey in mice

Honey is a natural sweet substance that bees produce by transforming flower nectar or other sweet secretions of plants. It has widespread use in traditional medicine in various parts of the world. It has been reported to assist in building the entire central nervous system. The beneficial effects of honey have been attributed to the possible polyphenolic contents and some other constituents. The geographical locations and the sources of plant nectars may contribute to the effects of honey samples. Thus, we evaluated the neuropharmacological effects of six samples of honey (10%, 20% and 40%(V)/v, p.o.) from three geographical locations of Nigeria using the following behavioral models: Novelty-induced behaviors (NIB), learning and memory, pentobarbital-induced hypnosis, anxiolytic, anticonvulsant, analgesic and antidepressant models in mice. The results showed that honey significantly (p< 0.05) decreased locomotion and rearing behaviors in NIB and amphetamine-induced locomotor activity when compared to the control group. Exploratory behavior was significantly increased in both holeboard and elevated plus maze but had no significant effect on spatial working memory. Honey sample from Umudike has significant hypnotic and anticonvulsant effects. The antinociceptive models (hot plate and tail flick tests) showed that the honey samples significantly increased the pain reaction time and naloxone blocked these central antinociceptive effects. The force swimming test showed that only the Idanre (ID) honey sample had antidepressant effect. In conclusion, some of these honey samples have central inhibitory property, anxiolytic, antinociceptive, anticonvulsant and antidepressant effects, thus may be used as nutraceutic. It can also be inferred that some of these effects are probably mediated through dopaminergic and opioidergic systems.

Use of complementary and alternative medicine and self-rated health status: results from a national survey

BACKGROUND

Despite the absence of conclusive evidence of effectiveness, complementary and alternative medicine (CAM) is used by 4 of 10 adults in the US; little is known about the association between CAM use and health status.

OBJECTIVE

To determine the relation between CAM use and self-reported health status and health improvement over time.

DESIGN AND PARTICIPANTS

We performed a secondary database analysis using data from the 2007 National Health Interview Survey of non-institutionalized US residents conducted by the National Center of Health Statistics of the Center for Disease Control. We identified CAM users and compared them to non-users. We used multivariable logistic regression to model the health status of respondents. We controlled for confounders including socio-demographic, clinical, and behavioral factors. The models were evaluated for discrimination and calibration.

MAIN MEASURES

The likelihood of respondents to report 'Excellent' current health and 'Better' health than in the prior year.

KEY RESULTS

Based on 23,393 respondents, we found 37% of U.S. adults used complementary and alternative medicine and 63% did not use any CAM. Compared to those who did not use CAM, CAM users were more likely to rate their health as 'Excellent' (adjusted-odds ratio (AOR) = 1.14, 95% CI = [1.03,1.26]). Similarly, CAM users were more likely to report their health as 'Better' than in the prior year (AOR = 1.64, 95% CI = [1.49,1.83]). The c-statistics for the two models were 0.755 and 0.616, respectively.

CONCLUSION

We found a significant association between CAM use and self-rated excellent health and health improvement over the prior year. Prospective trials are required to determine whether CAM use is causally related to excellent health status and better health than in the prior year.

The third therapeutic system: faith healing strategies in the context of a generalized AIDS epidemic

Faith healing in sub-Saharan Africa has primarily been studied qualitatively among Pentecostal-Charismatic groups, and considered as its own phenomenon with little attention to its relationship to other modes of healing. Using data from Malawi, a religiously diverse African country with high HIV prevalence, we find that faith healing is pervasive across multiple religious traditions. For individuals, attending a faith healing congregation is associated with lower levels of generalized worry about AIDS, and this association is driven by those who switched churches before AIDS became widespread in rural areas. Use of condoms and traditional medicine are, on the other hand, positively associated with worry about AIDS. We argue that faith healing can be understood as a third therapeutic system that coexists with the well-documented biomedical and traditional systems. The success of faith healing approaches lies in their unique ability to combine individual-pragmatic and communal-ritualized aspects of healing to inform interpretations of the AIDS epidemic and its consequences.

Rhus chinensis and Galla Chinensis--folklore to modern evidence: review

The species Rhus chinensis Mill. (Anacardiaceae) is an important representative of the genus Rhus, which contains over 250 individual species found in temperate and tropical regions worldwide. Rhus chinensis has long been used by folk medicine practitioners in Asia. Leaves, roots, stem, bark, fruit and particularly the galls on Rhus chinensis leaves, Galla chinensis, are recognized to have preventative and therapeutic effects on different ailments (such as diarrhea, dysentery, rectal and intestinal cancer, diabetes mellitus, sepsis, oral diseases and inflammation). However, it is critical to separate evidence from anecdote. Fortunately, recent scientific research has revealed that Rhus chinensis compounds possess strong antiviral, antibacterial, anticancer, hepatoprotective, antidiarrheal and antioxidant activities. Moreover, compounds isolated from the stem of Rhus chinensis significantly suppressed HIV-1 activity in vitro. Compounds from this plant were also found to inhibit enamel demineralization in vitro and enhance remineralization of dental enamel with fluoride. This review highlights claims from traditional and tribal medicinal lore and makes a contemporary summary of phytochemical, biological and pharmacological findings on this plant material. It aims to show that the pharmaceutical potential of this plant deserves closer attention.

European materia medica in historical texts: longevity of a tradition and implications for future use

AIM OF THE STUDY

This study uses historical texts in order to obtain information on the natural products used in traditional medicines in European/Mediterranean therapeutics over the last two millennia. The information obtained may lead to new directions in the area of drug discovery, as recent research has demonstrated the continued promise of looking to natural products for bioactive compounds. Researchers have increasingly turned to traditional medicines to provide clues as to which natural products to investigate, but the oral traditions on which much of this medical knowledge rests are often unstable. Thus researchers have been prompted to use historical medical texts, as this study does, to find potential sources of new drugs.

MATERIALS AND METHODS

This study uses twelve Mediterranean/European medical texts from the 5th century BC to the 19th century AD to compile a list of the most commonly used "simples"--or single action drugs substances--used in therapeutics in traditional European medicine. This list was then compared to present-day herbal pharmacopoeia as represented by the National Institutes of Health (NIH).

RESULTS

This study finds that traditional European materia medica was based on a Dioscoridean tradition that lasted through the 19th century with remarkably little variation, but is significantly different from the present-day herbal pharmacopoeia according to the NIH.

CONCLUSIONS

The most prominent simples in the European/Mediterranean medical tradition can provide clues to further bioactive compounds that have not as of yet been fully exploited for their potential, but were clearly of great use in the past.

Evaluation of the effect of lime fruit juice on the anticoagulant effect of warfarin

AIM

Citrus aurantifolia (Family Rutaceae) is commonly known as a familiar food and medicine, and s therapeutic effectiveness in a variety of diseases has been suggested in traditional medicine. Various complementary and alternative medicines (CAM) have been shown to interact with orthodox medicines. Hence, the aim of this study is to investigate such a phenomenon particularly the interaction of lime fruit juice with warfarin.

MATERIALS AND METHOD

Wistar strain albino rats of both sexes weighing between 190 and 230g were administered with oral doses of the respective drugs used depending on the groups of animals. Effects on the anticoagulant activity of warfarin were determined by standard laboratory methods.

RESULT

Lime fruit juice caused a reduction in the anticoagulant activity of warfarin.

CONCLUSION

This finding has shown that CAM can interact with orthodox medicines hence, warfarin prescribers need to be aware of the usage of CAM and monitor the international normalized ratio (INR) of their patients more frequently.

A cross-sectional study on the perceptions and practices of modern and traditional health practitioners about traditional medicine in Dembia district, north western Ethiopia

A cross-sectional study pertaining to the practices and perceptions of modern and traditional health practitioners on Traditional Medicine (TM) was carried out from February 25 to April 4, 2008. The results of the study showed that almost all the practitioners in both systems expressed their willingness to collaborate among each other to promote the positive elements of TM. As traditional healing knowledge is still being handed over from one generation to the next, mainly through word of mouth, which will lead to distortion or a total demise of the original knowledge, this report indicates the urgency to document the same. Moreover, the report also implies the need for educating and training the practitioners of the two systems. More also has to be done to create a discussion forum for both modern and TM practitioners, to enable them to share their knowledge. Government support for promotion and development of TM should be considered as a goal to be seriously pursued. The government should also contribute by helping them financially and by arranging training and education for the improvement of the healthcare system given to the public.

Traditional medicine in oman: its role in ophthalmology

Aim:

To present three patients with ocular disease who developed a range of complications following use of traditional medications.

Settings and Design:

Case series

Methods:

Three patients who were examined in the Ophthalmic department of a tertiary care teaching hospital in the Sultanate of Oman between 2003 and 2004, seeking care following use of traditional medicines and or healing practices for various ophthalmic problems described below.

Results:

The first patient was a computer professional with a chalazion; the patient used a plant extract from ‘Calotropis procera’ as a part of the treatment. He developed corneal edema with decrease in vision in his left eye following application of the plant extract. Treatment with topical steroids and antibiotics resulted in a complete clinical and visual recovery. The second patient developed a fungal corneal ulcer (dermatophyte - Trichophyton mentagrophyte) after sustaining injury with an animal tail to the right eye and used honey for pain relief prior to presentation. She responded poorly to anti-fungal treatment, underwent a penetrating keratoplasty with recurrence of infection in the graft that resulted in a vascularized corneal scar. The third patient was a five-year-old child who was treated with ‘wasam’ on the occiput for intraocular inflammation following bilateral uncomplicated cataract extraction. Following this treatment the topical steroid was discontinued. The ‘Wasam’ treatment indirectly resulted in exacerbation of the intraocular inflammation and secondary glaucoma and poor vision as well as ‘Wasam ulcers’ on the occiput. Despite treatment of the intraocular inflammation, the visual outcome was poor.

Conclusion:

Traditional medicine in Oman is sought by many for variable reasons. Lack of evidence-based scientific data on its safety or efficacy does not deter the Omanis from flocking the traditional healers. However, when applied in the treatment of ocular diseases, traditional medicine and healing practices seem to cause more harm than benefit for the patient.

Attitudes towards African traditional medicine and Christian spiritual healing regarding treatment of epilepsy in a rural community of northern Tanzania

Most people with epilepsy (PWE) live in developing countries with limited access to health care facilities. In sub-Saharan Africa with approximately 12 million PWE, 90% do not receive adequate medical treatment. In this context, traditional medicine, being easily accessible, plays an important role. However, in sub- Saharan Africa, studies on the attitude of people (both affected and not affected by epilepsy) towards traditional medicine for treatment of epilepsy are scarce. In this study, 167 people (59 PWE, 62 relatives, 46 villagers) were interviewed at the hospital and in the community with a semi-structured validated questionnaire regarding the prevailing attitude towards traditional medicine for treatment of epilepsy in a rural area of northern Tanzania. Various traditional healing methods (THM) could be ascertained, i.e. traditional herbal medicine, spiritual healing, scarifications and spitting. 44.3% (n=74/167) of the interviewed people were convinced that epilepsy could be treated successfully with THM. Interestingly, 34.1% (n=57/167) thought that Christian prayers could cure the cause and/or treat symptoms of epilepsy. Significantly more PWE and their relatives were in favour of THM compared to villagers not knowing about epilepsy or not being immediately affected by epilepsy (χ(2)-test, p=0.004). Further factors influencing people's attitudes towards THM were gender, tribe, religion and urbanity of people's dwellings. Our study demonstrates that not only THM but also prayers in the Christian sense seem to play an important role in people's beliefs regarding successful treatment of epilepsy. Factors influencing this belief system have been identified and are discussed.

Multiple impacts of epilepsy and contributing factors: findings from an ethnographic study in Vietnam

We investigated issues related to treatment, impact of epilepsy, attitudes toward epilepsy, and disclosure in Vietnam through in-depth interviews with people with epilepsy (PWE) and their family members. We found that although participants prefer Western to traditional treatment, they experience problems in accessing different kinds of antiepileptic drugs and higher-level treatment facilities and with respect to treatment expenses. The impact of epilepsy can be observed in a wide range of daily living activities which include working, education, marriage, and family formation. Although both families and society at large do not hold negative attitudes toward epilepsy, most PWE reported a sense of burden to others. Both PWE and family members generally prefer disclosing epilepsy rather than concealing it from others. Our findings strongly suggest a need in Vietnam for different types of antiepileptic drugs and epilepsy support information for PWE, family members, and the general public.

Ethnobotanical study of medicinal plants used by Sabaots of Mt. Elgon Kenya

Though the majority of people in Kenya and at Kopsiro Division in particular, rely on ethnomedicinal plant species to manage human ailments, the indigenous knowledge largely remains undocumented. Therefore, an ethnobotanical study was conducted on medicinal plant species used to manage human ailments at Kopsiro Division Mt. Elgon District Kenya. The objectives were to identify and document plants traditionally used for medicinal therapy by the Sabaots, to find out the method used for preparing and administering the drugs and to find out the conservation practices for the medicinal plants. Observations and semi-structured interviews were used to gather ethnobotanical data. 107 plants belonging to 56 families were identified and reported to be of medicinal value to the locals. Roots (47.3%) were the most frequently used parts of the plant followed by the bark (23.35%) then leaves (22.75%). The whole plant (1.8%), seed (1.2%), fruit (1.2%), sap (1.2%), flower (0.6%) and wood (0.6%) are least used in that order. The study revealed other hitherto undocumented medicinal plant species that may be new records for treating various ailments. Traditional medicine in Kopsiro division offers cheap, accessible and convenient remedy that suits the traditional lifestyle of the local community in comparison to the conventional medicine. Most medicinal plant species reported in this study were found to be under threat and this calls for urgent conservation measures so as to maximize the sustainable use of these vital resources in the study area.

Making the most of Papua New Guinea's biodiversity: Establishment of an integrated set of programs that link botanical survey with pharmacological assessment in "The Land of the Unexpected"

An integrated and coordinated set of programs has been established to meet ICBG goals in Papua New Guinea (PNG). Here we give an overview of the PNG ICBG and focus on the key elements and major steps taken to establish a program necessary for the pharmacological assessment of botanicals and traditional medicines in PNG and, by extrapolation, in other developing countries.

Utilization and practice of traditional/complementary/alternative medicine (TM/CAM) in South Africa

The aim of this study was to conduct a systematic review of published and unpublished research investigating the prevalence of traditional, complementary and alternative medicine (TMCAM) use in the general population. Results found that use of a traditional and/or faith healer seemed to have decreased over the past 13 years (from a range of 3.6-12.7% to 0.1%). The prevalence of traditional male circumcision was found to be 24.8% generally and 31.9% among the African Black racial group. The range of use of alternative and complementary medicine was from 0% to 2.2%. Local utilization surveys of TMCAM for the last illness episode or in the past year showed a variation in use of 6.1% to 38.5%. The prevalence of conditions treated at different TMCAM out-patients settings ranged from chronic conditions, complex of supernatural or psychosocial problems, mental illness, chronic conditions, acute conditions, generalized pain, HIV and other sexually transmitted infections. TM and probably CAM is used by substantial proportions of the general population, but differences in study design and methodological limitations make it difficult to compare prevalence estimates.

'They don't ask me so I don't tell them': patient-clinician communication about traditional, complementary, and alternative medicine

PURPOSE

Although high rates of traditional medicine and complementary and alternative medicine (TM/CAM) use have been well documented, there has been less attention to the factors influencing communication between patients and their primary care clinicians about TM/CAM. Such communication can be important in anticipating possible drug-herb interactions and in assuring agreement about therapeutic plans.

METHODS

We used sequential, multistage, qualitative methods, including focus groups, in-depth interviews, and a video vignette, to explore communication about TM/CAM between patients and their primary care clinicians. The study was conducted in RIOS Net (Research Involved in Outpatient Settings Network), a Southwestern US practice-based research network, situated largely in Hispanic and American Indian communities where TM/CAM is an important part of self-care.

RESULTS

One hundred fourteen patients, 41 clinic staff members, and 19 primary care clinicians in 8 clinic sites participated. The degree and nature of TM/ CAM communication is based on certain conditions in the clinical encounter. We categorized these findings into 3 themes: acceptance/nonjudgment, initiation of communication, and safety/efficacy. Perceived clinician receptivity to and initiation of discussion about TM/CAM strongly influenced patients' decisions to communicate; perceived clinician expertise in TM/CAM was less important. Clinicians' comfort with patients' self-care approaches and their level of concern about lack of scientific evidence of effectiveness and safety of TM/CAM influenced their communication about TM/CAM with patients.

CONCLUSIONS

Specific communication barriers limit patient-clinician communication about TM/CAM. Clinicians who wish to communicate more effectively with their patients about these topics and better integrate the types of care their patients use can change the communication dynamic with simple strategies designed to overcome these barriers.

Costus spicatus tea failed to improve diabetic progression in C57BLKS/J db/db mice, a model of type 2 diabetes mellitus

AIM OF THE STUDY

Costus spicatus Sw. (Costaceae) is a prominent medicinal herb used by Dominicans in the Dominican Republic and the United States for the treatment of diabetes, a growing epidemic in the Hispanic community. An ethnobotanical survey of the Dominican community in New York City revealed the popular use of a tea from the insulina plant to treat hyperglycemia. Insulina was identified as Costus spicatus. We tested the ability of a tea made from the leaves of Costus spicatus to alter glucose homeostasis in C57BLKS/J (KS) db/db mice, a model of obesity-induced hyperglycemia with progressive beta cell depletion.

MATERIALS AND METHODS

From 6 to 16 weeks of age, Experimental and Control animals (n=6/5) were given ad lib access to Costus spicatus tea or water, respectively.

RESULTS

Weight gain and progression of hyperglycemia and insulinopenia between the Experimental and Control groups were statistically indistinguishable. There was no difference between groups in average fed or fasting glucose and insulin concentrations. Intraperitoneal (IP) insulin tolerance testing after the 10-week study period showed that Costus spicatus tea consumption did not alter insulin sensitivity.

CONCLUSIONS

These data suggest that at the dose given, tea made from Costus spicatus leaves had no efficacy in the treatment of obesity-induced hyperglycemia. More investigation is needed to more fully explore dosages and the possible utility and biological activity of this common Dominican herbal remedy for the treatment of type 2 diabetes mellitus.

Pharmacognostical and preliminary phytochemical studies of Passiflora foetida

The plant Passiflora foetida (grandilla) has been used mainly for asthma and various neurological disorders by the traditional medicinal practitioners of Chittor District. Since proper information regarding this plant is not available, our efforts were devoted to fix the pharmacognostical parameters and preliminary phytochemical studies of Passiflora foetid. An attempt was made to fix the macroscopical, microscopical parameters of the leaf, quantitative microscopy, physical constants, behaviour of the powder with chemical reagents and preliminary qualitative phytochemical studies of Passiflora foetida were investigated. The phytochemical tests revealed the presence of sterols, flavanoids and carbohydrates.

Physical therapy and complementary and alternative medicine: an educational tool for enhancing integration

In an outpatient rehabilitation setting, both patients' use and therapists' knowledge of complementary and alternative medicine (CAM) varies widely. Based on this observation and a recognition of CAM as an emerging practice area for rehabilitation professionals, it was felt that a thorough and consistent approach to the education and orientation of physical therapists to the world of CAM and integrative care was needed. This special interest paper will describe one center's approach, development, and use of a unique and comprehensive training manual designed to provide both a structured and standardized approach for educating physical therapists about CAM and related therapeutic modalities. This innovative teaching tool allows for multiple methods of content delivery within a multidisciplinary format and can be used for those who practice currently or desire to practice in an integrative care environment.

Which medicine? Whose standard? Critical reflections on medical integration in China

There is a prevailing conviction that if traditional medicine (TRM) or complementary and alternative medicine (CAM) are integrated into healthcare systems, modern scientific medicine (MSM) should retain its principal status. This paper contends that this position is misguided in medical contexts where TRM is established and remains vibrant. By reflecting on the Chinese policy on three entrenched forms of TRM (Tibetan, Mongolian and Uighur medicines) in western regions of China, the paper challenges the ideology of science that lies behind the demand that all traditional forms of medicine be evaluated and reformed according to MSM standards. Tibetan medicine is used as a case study to indicate the falsity of a major premise of the scientific ideology. The conclusion is that the proper integrative system for TRM and MSM is a dual standard based system in which both TRM and MSM are free to operate according to their own medical standards.

Traditional Chinese medicine--what are we investigating? The case of menopause

CAM researchers commonly treat traditional medicines as unchanging systems. This article questions the validity of this approach by examining the treatment of menopausal syndrome by traditional Chinese medicine (TCM). Such treatment strategies were invented in 1964 and betray a strong influence of biomedical thinking. While they determine TCM treatment of menopausal syndrome in the West, physicians in China and Japan use many other treatment strategies from within the wider Chinese medical tradition in clinical practice. Cultural variability in the manifestation of menopausal syndrome furthermore questions the usefulness of simply importing treatment strategies from China to the West. This leads me to conclude that Chinese medicine as such can never be evaluated by means of clinical research. What we can do is use Chinese medicine as a resource for thinking about illness, and for formulating clinical interventions that may then be assessed using methods of evidence based research.

Pharmacognostical and preliminary phytochemical studies of achyranthes aspera linn

The whole plant of Achyranthes aspera has been used as remedy for a number of diseases such as dropsy, strangury, cough, kidney stones, dysentery and bowel complaints, According to traditional practice, a kheer prepared from the seeds of this plant is used to treat brain disorders. An attempt was made to fix the macroscopical, microscopical parameters of the leaf quantitative microscopy, physical constants, and behaviour of the powder with chemical reagents and preliminary qualitative phytochemical studies of Achyranthes aspera were investigated. The phytochemical tests revealed the presence of sterols, flavanoids tannins and carbohydrates.

Botanical immunodrugs: scope and opportunities

Modulation of the immune system can be addressed through a variety of specific and non-specific approaches. Many agents of synthetic and natural origin have stimulatory, suppressive or regulatory activity. There is growing evidence that drugs or biological agents capable of modulating single pathways or targets are of limited value as immune-related therapies. Systems biology approaches are now gaining more interest compared with monovalent approaches, which can be of limited benefits with complications. This has stimulated interest in the use of 'cocktails' of immunodrugs to restore immunostasis. Botanicals are chemically complex and diverse and could therefore provide appropriate combinations of synergistic moieties useful in drug discovery. Here, the importance of traditional medicine in natural product drug discovery related to immunodrugs is reviewed.

Alternate eye care services in a ghanaian district

OBJECTIVE

To determine eye care services sought outside the regular hospital system and their providers.

STUDY SETTING

Akwapim South district

METHOD

Questionnaire survey and in depth interviews.

RESULTS

We recruited 1,537 persons with a previous history of eye disease and alternate service providers (21 chemical shop attendants and 55 herbalists). There was no significant difference between patronage of the regular and the alternative providers (p value 0.78). Most of the herbalists were trained by relations; parents (29/55) and grandparents (10/55). Two thirds had some formal education and 96% practiced part-time. Over 75% claimed they treated cataracts, eye injuries, and "kooko" and 28% also treated red eyes. Chemical shop attendants were all literates, sold only antibiotic eye drops, and 64% practiced full time.

CONCLUSIONS

Herbalists and chemical sellers provided substantive eye care along the regular hospital services but some of their practices may be harmful.

Effect of Devil's Club Tea on Blood Glucose Levels in Diabetes Mellitus

Devil's club (Oplopanax horridum) is a popular medicinal plant used by Native Indian tribes in the Pacific Northwest. One reported indication for using this plant is in the treatment of diabetes mellitus. Several physicians have reported patients with diabetes who were able to maintain normal blood glucose levels while taking devil's club preparations. The authors performed a pilot study in which blood glucose levels were carefully monitored in an insulin-dependent diabetic patient, a newly diagnosed non-insulin-dependent diabetic, and two healthy adults while they drank devil's club tea. The limited data do not show any hypoglycemic effect of devil's club tea.

Folk healers: a different perspective

Non-western folk healers and their methods are often dismissed by westerners who feel that only physicians who have been well schooled in the Hippocratic tradition at an established university can provide health care adequately. The author, however, asserts that folk healers have a valuable role in medicine. A large percentage of the world's population relies on these practitioners as primary health care providers, and thus their contribution to medicine is considerable on a global scale. Similarly, treatments and pharmaceutical agents discovered by tribal healers have, on occasion, been keenly adopted by the west. Acknowledging the significance of this contribution can stimulate further study of alternative treatment options and philosophies.

The health of the james bay cree

The health of the James Bay Cree of Quebec reflects their history and environment. Their ancestors were living in Northern Quebec for centuries before the Europeans arrived bringing new infectious diseases and developing a health-care structure that has relegated traditional Cree medicine to the background. The James Bay and Northern Quebec Agreement of 1975 led to the creation of the Cree Board of Health and Social Services under the Quebec Ministry of Health. Various changes have resulted in the eight Cree villages over the past 15 years, both in the socio-economic situation and in the health status of the Cree. Improvements in health will come about through increased participation of Native people in the delivery and control of health services, more accessible health services, and the creation of healthy and health-promoting environments.