Traditional Chinese health beliefs adopt a holistic view emphasizing the importance of environmental factors in increasing risk of disease. According to Quah (1985), these factors influence the balance of body's harmony, yin and yang. These are two opposite but complementary forces and, together with qi (vital energy), they control the universe and explain the relationship between people and their surroundings. Imbalance in these two forces, or in the qi, results in illness.
In order to restore the balance, traditional remedial practices may be needed. For example, excess `hot' energy 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 specific chronic diseases, namely arthritis, musculoskeletal diseases and stroke, were more likely to use Traditional Chinese Medicine (TCM). This was strongly determined by the 'chronic disease triad', perceived satisfaction with care and cultural health beliefs.
Hence the use of TCM is not associated with the quality 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 regarding the nature and meaning of health and illness.
In traditional Chinese culture, taking medication is thought 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 certain antibiotics such as stomach upset may contribute to the poor adherence of medication. The use of "leftover", "shared" antibiotics and over-the-counter purchase of antibiotics by parents are common 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 improvement (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 usually seek cures from their religions.
In Singapore, the Ministry of Health has drawn up the TCM Practitioners' Ethical Code and Ethical Guidelines to prevent 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 suggested chronic 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 discussion to other issues such as when his father could go home.
Cultural Issues that may be involved 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 treatment in the elderly, as it may take a long time buy and sell misoprostol ph for them to accept the initial diagnosis.
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 medicine use in patients with chronic diseases in primary care is associated with perceived quality of care and cultural beliefs. Family Practice, 21(6): 654-660.
Subsidiary is a company that is controlled by another company through a parent child relationship. A company is only said to be a subsidiary company if the parent has controlling interest by owning over 50% of the issued share capital. A Subsidiary on its own may have subsidiaries. Subsidiaries are considered separate legal entities for taxation and regulation purpose.
Types of Subsidiaries – Three types of Subsidiaries can be formed namely:
-Public Limited Liability
-Minimum Capital – Must be paid by the founders (minimum two members)
-Shares – Can issue nominative or bearer shares
-Management – Should have at least three directors. One director should be a permanent resident of the country
-Private Limited Liability
-Minimum Capital – Must be paid by the founders
-Shares – Shares need to be nominative. Bearer shares cannot be subscribed
-Management – Managed by one or more managers
-Co-operative Company with limited liability
-Minimum Capital – Three partners are needed. One quarter of capital contribution must be paid-in
-Shares – Shares are nominative
-Management – A co-operative company with limited liability and managed by one or more managers
Parent Company mifepristone philippines – Subsidiary Relation
It is important that the subsidiary is recognized as an independent corporation managed by the board of directors even though it was incorporated by the parent company. This does not mean that the subsidiary is uncontrolled. The parent company has the legal authority to hold the subsidiary accountable to meet the financial objectives.
For the Parent company to control the independent subsidiary it should be:
-The sole shareholder
-Include voting control provisions in subsidiary article
-Prepare bylaws defining the authority of the officers, their term in the office and removal
-Prohibit bylaws amendment without shareholder's approval
As long as the parent company holds its subsidiary accountable for the expectations of its board of directors there is little risk for the parent to be found liable for the wrong doings of the subsidiary. But, if the parent company exercises excessive control for example has the same board of directors, use of common letterhead, in such case the parent company and the subsidiary are treated as one and the parent company is responsible for the subsidiaries debts etc.
Advantages and Disadvantages of Subsidiary
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-Liabilities and credit claims are locked in that subsidiary and cannot be passed on to the parent company
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-Legal paperwork involved with creating a subsidiary can be lengthy and expensive
-Control also becomes an issue when a subsidiary is partially owned by another outside organization