Postmodern values, attitudes and the use of complementary medicine

N-acetylcysteine does not alter neurometabolite levels in non-treatment seeking adolescents who use alcohol heavily: A preliminary randomized clinical trial

Current treatments for adolescent alcohol use disorder (AUD) are mainly psychosocial and limited in their efficacy. As such, pharmacotherapies are being investigated as potential adjunctive treatments to bolster treatment outcomes. N-acetylcysteine is a promising candidate pharmacotherapy for adolescent AUD because of its tolerability and demonstrated ability to modulate glutamatergic, GABAergic, and glutathione systems. The primary objective of this double-blind, placebo-controlled, within-subjects crossover preliminary investigation was to measure potential changes within glutamate + glutamine (Glx), GABA, and glutathione levels in the dorsal anterior cingulate cortex (dACC) using proton magnetic resonance spectroscopy during 10-days of N-acetylcysteine (1200 mg twice daily) compared to 10-days of placebo in non-treatment seeking adolescents who use alcohol heavily (N = 31; 55% female). Medication adherence was confirmed via video. Effects on alcohol use were measured using Timeline Follow-Back as an exploratory aim. Linear mixed effects models controlling for baseline metabolite levels, brain tissue composition, alcohol use, cannabis use, and medication adherence found no significant differences in Glx, GABA, or glutathione levels in the dACC after N-acetylcysteine compared to placebo. There were also no measurable effects on alcohol use; however, this finding was underpowered. Findings were consistent in the subsample of participants who met criteria for AUD (n = 19). The preliminary null findings in brain metabolite levels may be due to the young age of participants, relatively low severity of alcohol use, and non-treatment seeking status of the population investigated. Future studies can use these findings to conduct larger, well-powered studies within adolescents with AUD.

Slovenian Pet Owners' Experience, Attitudes, and Predictors Regarding Cannabinoid Use in Dogs and Cats

The aim of this study was to assess the personal experience and attitudes of Slovenian pet owners regarding cannabinoid (CBD) use and to identify the predictors of the first use and reuse of CBDs in dogs and cats. We hypothesized that positive attitudes toward CBDs, postmodern health values, and personal experience would be significant predictors of CBD use in animals. An open online survey targeted randomly selected Slovenian dog and cat owners, regardless of their experience with cannabis products. The questionnaire consisted of six sections related to demographic data and personal experience with CBD use, information about the participant's animal, experience with CBD use in the participant's animal, reasons for not using CBDs in their animal, attitudes toward CBD use in dogs and cats, and postmodern health values. Descriptive statistics were performed to analyze demographics, personal experience with CBD use, and experience with CBD use in dogs and cats. Hierarchical multiple regression using the enter method was performed to analyze the important predictors of CBD use. A total of 408 completed questionnaires were included in the statistical analysis. A substantial proportion (38.5%) of owners had already used CBDs to treat their animal. Positive attitudes and previous personal experience were significant (p < 0.05) predictors of first use and reuse of CBDs in pets, while postmodern health values were not. In conclusion, the decision to use CBDs for medicinal purposes is based on acquired information and personal experience. Veterinarians should be informed and familiar with CBDs as a treatment option. However, further research is essential to establish the use of CBDs in veterinary medicine. Improved laws and regulations are also needed to ensure that only high-quality medications are prescribed to dogs and cats.

Predictors of the use and approval of CAM: results from the German General Social Survey (ALLBUS)

BACKGROUND

Many studies have shown that sociodemographic variables significantly predict the use of complementary and alternative medicine (CAM), although these predictions were not particularly strong. A multitude of predictors of the use or approval of CAM have been investigated in the field of personal values and worldviews, but the effects were small or doubtful due to non-representative samples. More recent psychological research has linked positive attitudes towards CAM with intuitive thinking, paranormal beliefs, ontological confusions and magical health beliefs, suggesting a common thinking style behind all these variables. The aim of this study is to identify the most important predictors of the use and approval of CAM.

METHODS

We performed a canonical correlation analysis on all 3480 records from the 2012 German General Social Survey (ALLBUS) with the lifetime use and opinion of CAM as the dependent variables.

RESULTS

Approval of paranormal practices such as fortune-telling, dowsing or spiritualism explained 32% of the variance in the dependent canonical variate "approval of CAM", while sociodemographic variables explained only 2%. Experience with paranormal practices explained 17% of the variance in the dependent canonical variate "experience with CAM", and sociodemographic variables explained 10% of the variance. Traditional religiosity, attitudes towards science and post-materialist values showed no relevant correlations with the dependent canonical variates.

CONCLUSIONS

Paranormal beliefs and related measures are the most important known predictors of the use and approval of CAM. Experience with paranormal practices not only indicates paranormal beliefs but also explains experience with CAM that cannot be explained by approval of CAM. Female gender and higher socioeconomic status predict experience with CAM without predicting approval of CAM, but their influence should not be overstated.

Impact of a Formulation Containing Unusual Polyunsaturated Fatty Acids, Trace Elements, Polyphenols and Plant Sterols on Insulin Resistance and Associated Disturbances

INTRODUCTION

To evaluate the effect of a lipid-based formulation containing unusual polyunsaturated fatty acids, trace elements, polyphenols and plant sterols on insulin resistance and its associated disturbances among adults at risk of diabetes.

METHODS

This was an 8-week, three-arm, open-label randomized clinical trial. We studied individuals aged ≥ 18 years old with diabetes risk given by a body mass index ≥ 25 kg/m² or a FinnRisc score ≥ 13/20. Participants were randomly assigned to receive: 7 ml sunflower oil (control group), 3.5 ml of the study formulation + 3.5 ml of sunflower oil (low-dose group) or 7 ml of study formulation (high-dose group).

RESULTS

We randomized 25 individuals. After one withdrawal in the high-dose group, the study sample comprised nine patients in the control, nine in the low-dose and six in the high-dose groups. The insulin sensitivity increased significantly and in a dose-dependent fashion, up to 10% in the high-dose group. At week 8 the low-dose group exhibited lower glycemic excursions during the oral glucose tolerance test (OGTT), especially 1 h after the glucose challenge (32 mg/dl or 23% lower vs. control group). The incremental area under the glucose curve in the OGTT was 17.1% lower in the low-dose group vs. the control group. Waist circumference increased in the control group, remained constant in the low-dose group and decreased in the high-dose group. C-reactive protein decreased in both formulation groups, up to 50% in the high-dose group. Participants in the formulation groups exhibited increased secretion of GLP-1 and plasma irisin at week 8 vs. the control group.

CONCLUSION

The formulation induced favorable changes in insulin sensitivity, glucose tolerance, abdominal obesity and inflammation. These effects and their durability will need to be assessed in larger studies.

TRIAL REGISTRATION

NCT03512665.

FUNDING

Team Foods Colombia.

Attitudes Underlying Reliance on Complementary and Alternative Medicine

Objective: We aimed to map attitudes underlying complementary and alternative medicine (CAM) use, especially those involved in "dysfunctional CAM reliance," that is, forgoing biomedical treatment in a life-threatening situation in favor of alternative treatment. Analyses of modifiable determinants of CAM use were conducted at a sufficiently specific level to inform intervention development. Methods: We collected usable data on CAM-related attitudinal beliefs from 151 participants in Budapest with varying degrees of CAM use, which we analyzed using confidence interval-based estimation of relevance plots. Results: Although there were beliefs that the entire sample shared, there was a marked difference between the biomedical and CAM groups. These differences were beliefs concerning trust in various medical systems, the level of importance assigned to emotions in falling ill, and vitalism or Eastern concepts. Regarding CAM users in general, the most successful intervention targets are beliefs in vitalism on the one hand, and distrust in biomedicine on the other. In addressing dysfunctional CAM use specifically, the most significant beliefs pertain to "natural" cures and reliance on biomedical testing. Conclusions: Albeit much research has been carried out on the motivations behind CAM use, rarely do studies treat CAM users separately in order to scrutinize patterns of nonconventional medicine use and underlying cognition. This is the first study to begin pinpointing specific attitudes involved in dysfunctional CAM use to inform future intervention development. Such interventions would be essential for the prevention of incidents and mortality.

Characterizing Websites That Provide Information About Complementary and Integrative Health: Systematic Search and Evaluation of Five Domains

Background

In recent years, there has been an increase in the utilization of complementary and integrative health (CIH) care, and an increase in information-seeking behavior focused on CIH. Thus, understanding the quality of CIH information that is available on the internet is imperative. Although there have been a limited number of studies evaluating the quality of websites providing information about specific CIH-related topics, a broad evaluation of CIH websites has not been conducted.

Objective

This study was designed to fill that gap. We set out to assess website quality in 5 CIH domains: (1) acupuncture, (2) homeopathy, (3) massage, (4) reiki, and (5) yoga. This study aimed to 1) characterize the websites by type and quality; 2) evaluate website characteristics which may affect readers’ perceptions, specifically message content, structural features, and presentation style, and 3) investigate the extent to which harms, benefits and purposes of use are stated on websites.

Methods

This study employed a systematic search strategy to identify websites in each of the target domains to be evaluated. The websites were then classified by type, and a set of checklists focusing on quality, message content, structural features, and presentation style was used to evaluate the websites. Lastly, we performed content analysis to identify harms, benefits, and perceived purposes of use.

Results

There were similarities across domains regarding their overall quality and their message content. Across all domains, a high proportion of websites received strong scores in terms of ownership, currency, interactivity and navigability. Scores were more variable concerning authorship, balanced presentation of information and the use of sources of information. However, there were differences regarding their structural features and presentation style. Acupuncture and reiki sites tended to include more external links, and yoga, fewer. There was variation across domains in the extent to which the websites contained domain-specific terminology. Websites tended to provide an extensive list of potential benefits, while reporting of harms was scarce.

Conclusions

This is the first study to perform a multidimensional assessment of websites in multiple CIH domains. This review showed that while there are similarities among websites of different CIH domains, there are also differences. The diverse distribution of website types suggests that, regardless of CIH domain, the public encounters information through many different types of media, and it would be useful to consider how the presentation of this content may differ depending on the medium. The characteristics for which variability exist are areas that warrant greater attention from researchers, policy makers, clinicians and patients. There is also a need to better understand how individuals may interact with CIH websites, and to develop tools to assist people to interpret the CIH-related information that they encounter.

Naturopathy in Australia: Where are we now? Where are we heading?

Naturopathy is the general practice of natural therapies. It emphasizes prevention, treatment, and promotion of optimal health through therapeutic modalities which encourage the self-healing process of the body. Formalized in the 19th century by the hydrotherapy and nature cure movement in Austria and Germany, naturopathy was introduced to Australia at the turn of the 20th century. It became popular since the 1970s due to social and cultural change characterized by the post-modern philosophy, as well as government policies highlighting individual responsibility and freedom of choice. Naturopathy is one of the most popular forms of complementary medicine in Australia today with naturopaths received 4.9 million consultations annually. Naturopathic consultations are sought for a variety of conditions and, in some areas, as a form of primary care, especially by middle-aged women who have a higher education level and a higher annual income. The number of Australian naturopaths was estimated to be over 4000 in 2017 and expects to grow to over 4600 by 2022, although this number is likely to be an underestimation. Australian naturopaths, as a predominantly female profession, work mainly in private clinical practice with nutritional medicine, herbal medicine, homeopathy, as well as massage therapies being the most common modalities used. There are also signs of greater integration with community pharmacies and integrative medicine clinics in major cities. The Bachelor's degree programs in Naturopathy has just become the only accredited entry-level qualification since late 2015. Currently, there are only 5 private colleges offering naturopathic education, a far cry from the 40 over in mid-2000. The profession continues to be self-regulated. There is no barrier of entry to practice and unqualified practitioners of naturopathy can potentially do harm to the public. The registration of naturopaths remains unresolved due to fragmented representation under many professional associations, disunity among the profession, and objections by certain health care lobbyists. There is a dearth of research demonstrating efficacy of the whole practice of naturopathy in Australia, which has directed the government's decision to withdraw it from private health insurance coverage from 2019. Moving forward, the whole system research of naturopathy in Australia will be in focus with the recent establishment of a practice-based research network and an international research consortium. With increasing scrutiny from evidence-based medicine, the present and future challenge to Australian naturopaths is centered on the integration of both scientific and traditional evidence to form the foundation of a person-centered, evidence-informed practice.

Predicting the intention to use herbal medicines for anxiety symptoms: a model of health behaviour

Background: Anxiety is a prevalent mental health condition in the Western world. Adults experiencing anxiety have been found to use a range of herbal medicines to manage anxiety symptoms.Aim: This study aimed to test a theoretical model based on the theory of planned behaviour that predicted the intention to use herbal medicines for anxiety symptoms, and to identify individual predictors of intention.Methods: An online survey was conducted with Australian adults who experienced anxiety and used herbal medicines (N = 400). A two-step approach to structural equation modelling was used to test a path model predicting the intention to use herbal medicines.Results: The model was found to be well-fitting. Attitude, subjective norms, control beliefs and severity of anxiety symptoms each significantly positively predicted intention to use herbal medicines for anxiety symptoms explaining 56% of the variance.Conclusions: The results suggest that mental health practitioners and policy makers need to ensure people experiencing anxiety have access to accurate and reliable information about herbal medicines to ensure they can effectively manage anxiety symptoms and safely engage in self-care.

Why women choose compounded bioidentical hormone therapy: lessons from a qualitative study of menopausal decision-making

BACKGROUND

In recent years, compounded bioidentical hormone therapy (CBHT) has emerged as a popular alternative to manufactured, FDA approved hormone therapy (HT)-despite concerns within the medical community and the availability of new FDA approved "bioidentical" products. This study aims to characterize the motivations for using CBHT in a U.S. sample of ordinary midlife women.

METHODS

We analyze data collected from 21 current and former users of CBHT who participated in a larger qualitative study of menopausal decision-making among U.S. women. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed thematically using an iterative inductive and deductive process.

RESULTS

Although women's individual motivations varied, two overarching themes emerged: "push motivations" that drove women away from conventional HT and from alternative therapies, and "pull motivations" that attracted women to CBHT. Push motivations focused on (1) fear and uncertainty about the safety of conventional HT, (2) an aversion to conjugated estrogens in particular, and (3) and overarching distrust of a medical system perceived as dismissive of their concerns and overly reliant on pharmaceuticals. Participants also voiced dissatisfaction with the effectiveness of herbal and soy supplements. Participants were attracted to CBHT because they perceive it to be (1) effective in managing menopausal symptoms, (2) safer than conventional HT, (3) tailored to their individual bodies and needs, and (4) accompanied by enhanced clinical care and attention.

CONCLUSIONS

This study finds that women draw upon a range of "push" and "pull" motivations in their decision to use CBHT. Importantly, we find that women are not only seeking alternatives to conventional pharmaceuticals, but alternatives to conventional care where their menopausal experience is solicited, their treatment goals are heard, and they are engaged as agents in managing their own menopause. The significance of this finding goes beyond understanding why women choose CBHT. Women making menopause treatment decisions of all kinds would benefit from greater shared decision-making in the clinical context in which they are explicitly invited to share their experiences, priorities, and preferences. This would also provide an opportunity for clinicians to discuss the pros and cons of conventional HT, CBHT, and other approaches to managing menopause.

Parental attitudes toward pediatric use of complementary/alternative medicine in Turkey

PURPOSE

This study was conducted to determine the pediatric usage of complementary/alternative medicine (CAM) by parents in Turkey, the incidence of using these methods, and the factors affecting their use.

DESIGN AND METHODS

The sectional and relational design of the study included a sample of 497 parents who took children for treatment at the Maternity and Children's Hospital in Giresun, Turkey. Data for the study were collected via the Personal Information Form and the Evaluation Form for Complementary/Alternative Treatment Use. The data collection tools were filled out by the researchers during the face-to-face interviews. Data obtained from the study were analyzed by Pearson chi-square, Fisher-Freeman-Halton and Fisher's exact (posthoc Bonferroni) tests and Z-test.

RESULTS

It was determined that 97.7% of the parents had used at least one CAM method. Moreover, the parents had used CAM methods mostly for respiratory complaints. The CAM methods were most commonly used for the symptoms of fever, diarrhea, and cough. It was observed that the most commonly used alternative methods in the past were vitamin/mineral remedies, cold treatments, and hodja (Islamic teacher) consultations, while the most common alternative methods currently used are massage, music, and cold treatment. In addition, the differences found between CAM users in terms of sociodemographic characteristics were not statistically significant.

PRACTICE IMPLICATIONS

It is crucial for nurses to learn the characteristics of the health/disease treatments used by those with whom they work in order to increase the efficiency of the service they provide. Thus, it was recommended that nurses should be knowledgeable and aware of the benefits/side effects, treatment methods, and contraindications of CAM.

A Systematic Review of Beliefs Involved in the Use of Complementary and Alternative Medicine

People might be attracted to and use complementary and alternative medicines (CAM) because they hold beliefs that are congruent with CAM. This article collates, examines and synthesizes the evidence surrounding this hypothesis. Most studies are cross-sectional and focus on a limited number of beliefs. Multivariate studies suggest that beliefs related to control and participation, perceptions of illness, holism and natural treatments, and general philosophies of life predict CAM use when controlling for demographic and clinical factors. Further research should examine the robustness of these relationships in different illness groups and the prospective relationships among beliefs and CAM use over time.

Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use

BACKGROUND

There is increasing evidence that complementary medicine (CM) services are being used by a substantial proportion of the Australian population and this topic has attracted keen interest from primary health care providers and policy makers. This article outlines the first summative critical review of the predictors of CM use in Australia as well as the characteristics and perceptions of Australian CM users over the last 14 years.

METHODS

A literature search was conducted to ascertain original research from 2000 to 2014 in the AMED; CINAHL; and PubMed databases. Selected articles were subject to a critical appraisal analysis to identify the quality of the article. The search was confined to peer reviewed original articles published in English which identified the nature of CM services use in Australia.

RESULTS

The findings indicate a correlation between CM users and gender, with reports of a higher rate of use from females compared to males. Female CM users are more likely to be middle-aged with a higher education and higher annual income in comparison to female non-CM users. An association between resident location and use of CM disciplines was also identified with reports of rural residents utilising manual therapies more frequently compared to urban residents. CM users are more likely to seek CM services for a range of chronic conditions including diseases identified as National Health Priority Areas by the Australian Government.

CONCLUSIONS

This article provides the first comprehensive review examining the nature of CM use in Australia. The review findings offer important insights into the characteristics and features of CM use in Australia and provide insights for national and regional primary health care initiatives and of interest to medical doctors, allied health professionals, CM practitioners, researchers and policy makers.

Herbal medicine use in adults who experience anxiety: A qualitative exploration

Herbal medicine use is widespread and has been reported to be as high as 21% in people with anxiety disorders. Critical thematic analysis was used to explore beliefs and attitudes towards herbal medicines in adults experiencing anxiety. In-depth interviews were conducted with eight adults who experienced anxiety and used herbal medicines. Three major themes were found: Herbal medicines being different from pharmaceuticals, evidence and effectiveness, and barriers to herbal medicine use. Within these themes people held beliefs about the safety of natural treatments, valued anecdotes from friends and family as a form of evidence for self-prescribing, and described confusion about herbal medicines and their cost as barriers to using them as a treatment option. The findings will inform future research and provide guidance for health practitioners.

Social network bridging potential and the use of complementary and alternative medicine in later life

The use of complementary/alternative medicine (CAM) is typically modeled as a function of individual health beliefs, including changes in perceptions of conventional medicine, an orientation toward more holistic care, and increasing patient involvement in health care decision-making. Expanding on research that shows that health-related behavior is shaped by social networks, this paper examines the possibility that CAM usage is partly a function of individuals' social network structure. We argue that people are more likely to adopt CAM when they function as bridges between network members who are otherwise not (or poorly) connected to each other. This circumstance not only provides individuals with access to a wider range of information about treatment options, it also reduces the risk of sanctioning by network members if one deviates from conventional forms of treatment. We test this idea using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative study of older Americans. Analyses of egocentric social network data show that older adults with bridging potential in their networks are significantly more likely to engage in a greater number of types of CAM. We close by discussing alternative explanations of these findings and their potential implications for research on CAM usage.

The Sociology of Traditional, Complementary and Alternative Medicine

Complementary and alternative medicine (CAM) and traditional medicine (TM) are important social phenomena. This article reviews the sociological literature on the topic. First, it addresses the question of terminology, arguing that the naming process is a glimpse into the complexities of power and history that characterize the field. Second, focusing on the last 15 years of scholarship, it considers how sociological research on users and practitioners of TM/CAM has developed in that time. Third, it addresses two newer strands of work termed here the 'big picture' and the 'big question'. The big picture includes concepts that offer interpretation of what is happening at a societal level to constrain and enable observed patterns of social practice (pluralism, integration, hybridity and activism). The big question, 'Does it work?', is one of epistemology and focuses on two developing fields of critical enquiry - first, social critiques of medical science knowledge production and, second, attempts to explain the nature of interventions, i.e. how they work. Finally, the article examines the role of sociology moving forward.

Undoing gender? The case of complementary and alternative medicine

Despite a rich body of sociological research that examines the relationship between gender and health, scholars have paid little attention to the case of complementary and alternative medicine (CAM). One recent study (Sointu 2011) posits that men and women who use CAM challenge traditional ascriptions of femininity and masculinity through the exploration of self-care and emotions, respectively. Drawing on 25 in-depth interviews with middle-class Americans who use CAM, this article instead finds that men and women interpret their CAM use in ways that reproduce traditional gendered identities. Men frame their CAM use in terms of science and rationality, while simultaneously distancing themselves from feminine-coded components of CAM, such as emotions. Women seek CAM for problems such as abusive relationships, low self-esteem, and body image concerns, and frame their CAM use as a quest for self-reinvention that largely reflects and reproduces conventional femininity. Further, the reproduction of gendered identities is shaped by the participants' embrace of neoliberal tenets, such as the cultivation of personal control. This article contributes to ongoing theoretical debates about the doing, redoing and undoing of gender, as well as the literature on health and gender.

Understanding support for complementary and alternative medicine in general populations: Use and perceived efficacy

Proponents of complementary and alternative medicine argue that these treatments can be used with great effect in addition to, and sometimes instead of, conventional medicine, a position which has drawn sustained opposition from those who advocate an evidence-based approach to the evaluation of treatment efficacy. Using recent survey data from the United Kingdom, this article seeks to establish a clearer understanding of the nature of the public’s relationship with complementary and alternative medicine within the general population by focusing on beliefs about the perceived effectiveness of homeopathy, in addition to its reported use. Using recent data from the United Kingdom, we initially demonstrate that reported use and perceived effectiveness are far from coterminous and argue that for a proper understanding of the motivations underpinning public support of complementary and alternative medicine, consideration of both reported use and perceived effectiveness is necessary. We go on to demonstrate that although the profile of homeopathy users differs from those who support this form of medicine, neither outcome is dependent upon peoples’ levels of knowledge about science. Instead, the results suggest a far greater explanatory role for need and concerns about conventional medicine.

Complementary or controversial care? The opinions of professionals on complementary and alternative interventions for Autistic Spectrum Disorder

The use of complementary and alternative interventions is growing and gaining popularity, both in the UK and internationally, with significant financial and emotional implications. Complementary and alternative interventions are often utilised by parents of children with Autistic Spectrum Disorders and research has investigated parental beliefs. There is, however, limited understanding regarding what professionals believe about the use of alternative treatments. In this paper we explore the opinions of a range of different professionals about alternative treatments and found that while some have an open-minded opinion, there was a tendency to hold beliefs that these treatments are ineffective, that they give false hope and have potential to harm the child. We discuss the implications for this in terms of the importance of an open dialogue between professionals and families and consider the importance of this in relation to the popularity of these interventions.

Patient expectations of 'effectiveness' in health care: an example from medical herbalism

AIMS AND OBJECTIVES

The study explored people's experiences of medical herbalism, with the aim of enhancing understanding about the use of herbalism in the context of contemporary UK health care.

BACKGROUND

The popularity and use of complementary and alternative medicine in westernised societies is now well documented, and medical herbalism, in particular, is enjoying a particularly strong revival of interest. Despite this, the reasons for its sustained popularity remain unclear.

DESIGN

The study was underpinned by Gadamerian hermeneutic phenomenology.

METHOD

Nineteen adult clients of medical herbalists were interviewed about their experiences. The processes of data collection and data analysis were informed predominantly by van Manen's phenomenological framework and by Kvale's framework for interview-based studies.

RESULTS

Herbalism more closely met participants' expectations of effective health care. The themes 'dealing with illness causation', 'patient-practitioner collaboration' and 'provision of authentic evidence' were fundamental to achieving effectiveness but were perceived as more easily attainable in the context of medical herbalism.

CONCLUSIONS

Health care is more likely to meet the expectations of patients when its purposes, methods and goals are negotiated and made explicit, from the perspectives of both patient and health care professional. Medical herbalism has the potential to contribute usefully to participants' healthcare, especially when used selectively and in conjunction with conventional health care.

RELEVANCE TO CLINICAL PRACTICE

The continued popularity of complementary and alternative medicine amongst the general public makes its acknowledgement in conventional health care more important than ever. In the context of the integrative health movement, it is therefore essential that health care professionals develop their understanding about patient practices and preferences, if a responsive health care system is to be maintained. Nurses are in a prime position to influence the knowledge base and future direction of integrative health care, especially in relation to the patient perspective.

Let your intuition be your guide? Individual differences in the evidence-based practice attitudes of psychotherapists

RATIONALE, AIMS AND OBJECTIVES

Despite increasing dissemination efforts, many psychotherapists still do not use treatments that are supported by research. Some have claimed that psychotherapists rely more on their clinical intuition than scientific evidence when making treatment decisions, but there is a paucity of research on this topic. The aim of the study was to examine the relationship between intuition and therapists' attitudes towards evidence-based practices (EBPs).

METHODS

Psychotherapists from diverse professional backgrounds completed an Internet-based survey that assessed EBP attitudes, reliance on an intuitive thinking style, attitudes about alternative therapies and endorsement of erroneous health beliefs that are not supported by scientific evidence.

RESULTS

Regression analyses showed that an intuitive thinking style was associated with several dimensions of EBP attitudes, including more negative attitudes towards research, less openness to research-based treatments, and less willingness to use evidence-based treatments if required to do so, even after controlling for background factors such as education level. Furthermore, a tendency to rely on intuition was associated with more positive attitudes towards alternative therapies and the endorsement of erroneous health beliefs.

CONCLUSIONS

Most dissemination efforts targeted at psychotherapists focus only on education about EBPs. However, results of this study suggest that dissemination efforts may need to more directly address the potential barriers to using EBPs (i.e. reliance on intuition) to be optimally effective in changing therapists' attitudes and behaviours.

Research on integrative healthcare: context and priorities

It is important that integrative healthcare research be conducted to optimize the effectiveness, safety, costs, and social and economic impact of prospective, personalized, patient-centered, comprehensive, and holistic healthcare that focuses on well-being as well as disease management, and that the research itself be well understood. The scope of this research extends beyond evaluation of specific therapies, to include evaluations of multimodality whole system intervention, practitioner-patient relationships, patient goals and priorities, promoting self-care and resilience, personalized diagnostic and therapeutic measures, practitioner well-being, the comparative effectiveness of different educational and outreach strategies in improving health and healthcare, and the environmental/social causes and consequence of health and healthcare. In this paper, we describe the state of the science of research on integrative healthcare, research needs, and opportunities offered by cutting-edge research tools. We propose a framework for setting priorities in integrative health research, list areas for discussion, and pose a few questions on a future research agenda.

Attitudes toward and education about complementary and alternative medicine among adult patients with depression in Taiwan

AIMS

To investigate patients' attitudes toward complementary and alternative medicine, the education nurses provided about complementary and alternative medicine for treating depression and to test whether such education mediates the effect of complementary and alternative medicine use and attitudes toward complementary and alternative medicine.

BACKGROUND

Although we know that attitudes influence behaviour, very few studies simultaneously explore the relationship between attitudes, education and complementary and alternative medicine use.

DESIGN

Survey.

METHODS

This study was conducted as part of a larger survey, using face-to-face survey interviews with 206 adult patients aged 50 years or over and hospitalised in conventional hospitals in Taiwan for treatment of depression. The attitudes toward complementary and alternative medicine and patient education about complementary and alternative medicine instruments were specially developed for the study.

RESULTS

Participants expressed slightly favourable attitudes toward complementary and alternative medicine. Many participants (50%) expressed that they were willing to try any potential treatment for depression. They believed that complementary and alternative medicine helped them to feel better and to live a happier life. However, 66.5% of participants reported that they had inadequate knowledge of complementary and alternative medicine. Participants with a higher monthly income, longer depression duration and religious beliefs hold more positive attitudes toward complementary and alternative medicine. Most participants were not satisfied with the education they received about complementary and alternative medicine. Patient education about complementary and alternative medicine was found to be a mediator for the use of complementary and alternative medicine.

CONCLUSION

Patient education from nurses may predict patients' attitudes toward complementary and alternative medicine. Continuing nursing education is needed to enable nurses to respond knowledgeably to concerns patients may have about complementary and alternative medicine and treatment options.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the potential role of patient education about complementary and alternative medicine as an effective way of adjusting patients' attitudes toward complementary and alternative medicine and to link both patients' preferences for complementary and alternative medicine and health professionals' concerns about the proper use of complementary and alternative medicine for depression management and adverse drug interactions.

Why consumers maintain complementary and alternative medicine use: a qualitative study

OBJECTIVES

Although research evidence exists to suggest why consumers use complementary and alternative medicine (CAM), there remains a need to distinguish between factors and processes involved in the initial uptake of therapies and those involved in their subsequent maintenance. We therefore conducted a qualitative study to explore and describe consumers' reasons for maintaining or stopping CAM use.

METHODS

This was a qualitative study. We interviewed 46 CAM consumers and 9 CAM practitioners, in two high-street CAM clinics in the UK. The interviews were analyzed thematically using techniques from grounded theory.

RESULTS

Consumers described and evaluated their CAM experiences along four dimensions: interpersonal (e.g., interactions with practitioners), physical (e.g., sensations such as touch or pain during treatment), affective (e.g., empowerment), and cognitive (e.g., beliefs about treatment). They evaluated their experiences in relation to their individual needs and expectations; financial considerations could limit maintenance of CAM use. Practitioners emphasized the effectiveness of treatment and themselves as contributing to consumers maintaining treatment, and recognized the role of financial considerations in decisions to stop CAM use.

CONCLUSIONS

This study suggests that experiences of conventional medicine are of limited importance after the decision to initiate CAM. Experiences of CAM were foremost in our consumers' decisions to maintain or stop specific CAM therapies. Maintenance of CAM could occur even if consumers' experiences were not entirely positive. Our findings provide novel, systematic insights that will be of particular interest to practitioners who want to support consumers as they decide whether to maintain CAM use.

Practitioner-client relationships in integrative medicine clinics in Australia: a contemporary social phenomenon

OBJECTIVES

The increasing use of complementary and alternative medicine (CAM) in developed countries has been attributed more to contemporary cultural trends than to inherent problems in mainstream medicine. The aim of this study was to examine the impact of post-modern values on relationships between practitioners and clients in integrative medicine (IM) clinics in Australia.

DESIGN

This research used hermeneutic phenomenology to uncover experiences of practitioner-client relationships in IM and the meanings clients and practitioners attached to these relationships. Data were collected using cumulative case studies, focus groups and key informant interviews. Data analysis consisted of reading and re-reading texts derived from interview transcripts and field notes and constantly comparing texts to identify meanings and patterns. Themes extracted from the data set were continually refined, discarded and elaborated until meta-themes emerged.

SETTING

Australian IM clinics where general medical practitioners and CAM practitioners were co-located.

RESULTS

Post-modern values were evident in practitioner-client relationships in Australian IM clinics and were manifested in two ways. (1) Clients did not bring an expectation that they would receive prescriptive treatment regimens. They regarded consultations as opportunities for obtaining information or advice, or for monitoring their health. (2) Practitioners valued clients' knowledge and judgments and respected clients' right to choose and direct their health care.

CONCLUSIONS

In the IM clinics in this research, the traditional role of the practitioner as sole possessor of expertise had changed. Practitioners had become one among a number of resources that informed clients used when designing personal health care plans or negotiating health care with practitioners.

Simply because it works better: exploring motives for the use of medical herbalism in contemporary U.K. health care

AIM

To clarify the reasons underlying people's use of medical herbalism in the context of contemporary U.K. health care.

DESIGN

This qualitative, interpretative study recruited 19 adults who were consulting with registered medical herbalists in a region of southern England. Participants were interviewed about their experiences and the data were analysed thematically. Study methodology was informed by Gadamerian hermeneutic phenomenology.

RESULTS

Few of the participants had initially set out to try herbalism, most looking for 'an alternative' to conventional health care. The main reason for exploring non-conventional options was to seek out health care that would more effectively meet their self-perceived needs in the treatment of a chronic condition. As a result of favourable outcomes from their initial treatment, participants subsequently continued to use herbalism for the management of more general, everyday health problems.

CONCLUSIONS

Lay and professional ideas about what constitutes health care 'effectiveness' do not necessarily correspond. Participants reported that, in comparison to conventional medicine, medical herbalism satisfied their expectations of health care because it more readily met their own criteria for effectiveness and because it had greater consistency with their own understanding about health, illness and health care. Central to achieving this was the collaborative nature of the herbalist's approach, as well as the therapeutic effect and enduring history of the herbal therapy itself. Participants were in favour of a future integrative health care system provided this did not interfere with the unique attributes of herbalism that make it distinct from conventional medicine.

Women's needs for CAM information to manage menopausal symptoms

OBJECTIVE

To identify the information needs of women regarding complementary and alternative medicine (CAM) treatment options to alleviate menopausal symptoms.

METHODS

Self-administered questionnaires were mailed to women responding to notices posted in family physicians' offices and a women's health center. Survey questions addressed preferred topics, formats and sources of information; experiences with information searching; and what signified good, trustworthy information.

RESULTS

The women in this study (n = 413) indicated several challenges including a lack of time to gather information, gaps in, and lack of, relevant information, and poor information quality. They expressed interest in information about the menopausal process, conventional and CAM treatment options, and the safety of treatments. Personal consultation with health-care professionals was the preferred way for obtaining information. The majority of women preferred evidence-based information but there was also a substantial number of women who chose to rely on 'softer' evidence such as personal accounts. These results suggested two different subgroups; however, the data indicate that these are not mutually exclusive since many respondents showed a preference for both types of information.

CONCLUSIONS

Women feel they are not sufficiently informed to make safe decisions regarding CAM treatment options to alleviate menopausal symptoms. Family physicians are a trusted information source and have an important role in providing women with that information. Brochures containing evidence-based information and a list of newsletters or books that include personal accounts, available in physician's offices and during personal consultations at women's health centers, are offered as a possible solution. A website is another possibility for distributing this information.

Complementary medicine use among attendees at a rural health screening clinic

The objective of this study was to investigate the use of complementary and alternative medicines (CAM) in a group of older rural Australian attending a multi-disciplinary health screening clinic. The average age of all participants (n=102) was 66+/-10 years (range 49-89) and 61% were female. Three-quarters (78%) of respondents had used at least one CAM product within the past 12 months and 66% had visited a CAM practitioner. The most frequently used CAM were vitamin/mineral supplements (54%) followed by herbal supplements (28%). Among products named by respondents that they were currently using the most frequently cited were omega-3/fish oils (28%) and glucosamine (24%). The main source of information for most respondents (53%) was doctors and pharmacists followed by family and friends (28%). Almost half (46%) had not discussed their use of CAM with their doctor and only 15% had discussed their CAM use with a pharmacist. Respondents were not found to hold strongly pro-CAM or anti-CAM health beliefs. This study demonstrates that while older, rural Australians do not have significant pro-CAM beliefs they do have high use of CAM. Based on the types of products used it is suggested that CAM use forms part of these individuals' self-management strategies.

Treatment appraisals and beliefs predict adherence to complementary therapies: a prospective study using a dynamic extended self-regulation model

OBJECTIVES

Complementary and alternative medicine (CAM) is used by large numbers of the general public and is increasingly becoming integrated into the mainstream. An understanding of why people use CAM in general has been developed in the literature, but relatively little is known specifically about adherence to CAM. We tested hypotheses (derived from a dynamic extended version of Leventhal's common-sense model) that patients' beliefs about treatment, perceptions of illness, and treatment appraisals would predict adherence to CAM.

DESIGN

A prospective self-report questionnaire study was carried out with a 3-month follow-up period.

METHODS

A total of 240 patients from five CAM clinics completed self-report questionnaire measures of treatment beliefs, illness perceptions, and treatment appraisals at baseline. Three months later, they completed self-report measures of adherence to therapists' recommendations concerning attendance, remedy use, and life-style changes.

RESULTS

Logistic regression analyses showed that positive perceptions of one's therapist and belief that mental factors do not cause illness independently predicted adherence to appointments. Positive beliefs in holistic health and finding it difficult to travel to appointments predicted adherence to remedy use. Using homeopathy was the only independent predictor of adherence to life-style changes.

CONCLUSIONS

Treatment appraisals, treatment beliefs, and illness perceptions explain modest proportions of the variance in adherence to CAM. This study highlights the value of operationalizing the appraisal element of the common-sense model when investigating adherence to treatment.

Exploring predictors of health sciences students' attitudes towards complementary-alternative medicine

This study demonstrated that a less scientific worldview predicted health science (HS) students' positive attitude towards complementary-alternative medicine (CAM), independently of important background characteristics as gender, pre-college science immersion, age, and type of HS education of the students. A total of 473 students in their final 3rd year of education in the health sciences (nursing, physiotherapy, social educator, and radiography) participated in teh study, which was based on a questionnaire consisting of items mapping student background characteristics and their attitudes towards worldview reflecting statements in constructs. The results showed that large fractions of the HS students were positive towards the use of CAM treatments. Multiple regression analysis demonstrated that 24 % of the total variance in HS students' positive attitude towards the use of CAM than the HS students' background characteristics alone, which accounted for only 2 % of the total variance. HS students' Paranormal beliefs, and their Willingness to include CAM in HS education were the most important predictors. The study results suggest stronger emphasis on teaching about epistemologies in HS educations.

Demographics and patterns of acupuncture use in the Chinese population: the Taiwan experience

BACKGROUND

The use of complementary and alternative medicine (CAM), including Traditional Chinese Medicine (TCM) and acupuncture, has substantially increased in western countries in the past decade. However, informative data concerning large-scale investigations of acupuncture used in the Chinese society remain rare so far. DESIGN AND OUTCOME MEASURE: The complete datasets of acupuncture outpatient reimbursement claims from 1996 to 2002 were supplied by the National Health Insurance Research Database, Taiwan, and the usage frequencies and characteristics of the acupuncture users, as well as the disease categories that were treated by acupuncture in Taiwan were analyzed.

RESULTS

At the end of 2002, among the 21,869,478 total valid beneficiaries of National Health Insurance (NHI), 1,362,351 subjects (6.2%) used acupuncture during this year, but 4,948,464 subjects (22.6%) had used it for the whole 7-year period since 1996. A mean increment of 1,191,164 (53.6%) new users had been involved yearly. Among all those acupuncture users, a female predominance was observed (female:male = 1.12:1), and the age distribution displayed a peak at around the 40s, followed by the 30s and 50s. Private TCM clinics provided more acupuncture usage (82.0%) than did private TCM hospitals (13.7%). The disease categories treated mostly by acupuncture were diseases of the musculoskeletal system (46.2%); injury (41.8%); diseases of the nervous system (3.5%); and symptoms, signs, and ill-defined conditions (2.7%).

CONCLUSIONS

Twenty-three percent (23%) of people in Taiwan had used acupuncture during this 7-year period. Musculoskeletoal and neurologic disorders were two major categories commonly treated with acupuncture.

Judgements without rules: towards a postmodern ironist concept of research validity

The past decade has seen the gradual emergence of what might be called a postmodern perspective on nursing research. However, the development of a coherent postmodern critique of the modernist position has been hampered by some misunderstandings and misrepresentations of postmodern epistemology by a number of writers, leading to a fractured and distorted view of postmodern nursing research. This paper seeks to distinguish between judgemental relativist and epistemic relativist or ironist positions, and regards the latter as offering the most coherent critique of modernist/(post)positivist nursing research. The writings of poststructuralist philosophers, including Barthes, Lyotard, Derrida, Foucault and Rorty are examined, and a number of criteria for a postmodern ironist concept of research validity or trustworthiness are suggested. Whilst these writers reject the idea of Method as a guarantee of valid research, they nevertheless believe that value judgements can and must be made, and turn to notions of ironism, différance, and the different. Ultimately, the postmodern ironist reader of the research report must make a judgement without criteria, based on her own practical wisdom or 'prudence'.

Reasons for Choosing and Complying with Complementary Health Care: An In-House Study on a South Australian Clinic

OBJECTIVE

The aim of this study was to explore the reasons why clients initially consult a complementary and alternative medicine (CAM) practitioner, the reasons that influence clients to seek treatment, and the factors that influence clients to be compliant with their treatment.

DESIGN

A combination of quantitative and qualitative methods were used. Quantitative data were obtained via a self-completion survey (n = 158). Qualitative information was derived from eight semistructured interviews.

SETTING

The study took place in a clinic in Norwood, South Australia. Participants were primarily residents of the eastern suburbs of Adelaide.

SUBJECTS

The study involved a convenience sample of clients.

RESULTS

Survey and interview results demonstrated that clients access CAM practitioners not solely for improvement of physical symptoms, with 54% of clients indicating a desire for counseling for general health issues and 50% wanting dietary and nutritional treatment. Of the subjects 36% sought increased self-insight and benefit from a wider perspective of healing. In addition 55% of respondents indicated that quality of relationship between CAM and client has a major impact on compliance and continuity of treatment, which in turn affects the overall success of the treatment.

CONCLUSIONS

Clients in this clinic accessed complementary health care for a variety of reasons including gaining another perspective on their health. It suggests that CAM does not replace conventional medicine but may be used as an adjunct to conventional medicine.

Developing a measure of treatment beliefs: the complementary and alternative medicine beliefs inventory

OBJECTIVES

The study aimed to develop a comprehensive generic measure of treatment beliefs, the Complementary and Alternative Medicine Beliefs Inventory (CAMBI), and to identify distinct dimensions of CAM-related beliefs.

METHODS

The CAMBI and other measures were presented and advertised online.

RESULTS

328 completed questionnaires were received. Factor analysis indicated three dimensions of beliefs could be identified. Subscales of the CAMBI were developed measuring beliefs in natural treatment, participation in treatment and holistic health. The subscales all had satisfactory reliability and were significantly correlated with CAM use (Spearman's rho=.18, .47 and .22 for natural treatments, holistic health and participation in treatment, respectively).

CONCLUSIONS

The CAMBI measures three distinct dimensions of treatment beliefs, all of which are related to CAM use.

Attitudes of Australian pharmacists toward complementary and alternative medicines

BACKGROUND

The increase in the use of complementary and alternative medicine (CAM) by the general public has led to increasing interest in how health professionals view these therapies.

OBJECTIVE

To determine the knowledge and attitudes of pharmacists toward CAM.

METHODS

An anonymous, self-administered questionnaire was designed and mailed to 1500 randomly selected pharmacists in New South Wales, Australia.

RESULTS

Four hundred eighty-four responses were received, with 77% of respondents indicating that they had personally used CAM and 60% correctly identifying that CAM was comprised of more than just botanicals and nutritional agents. The most commonly used CAMs were herbal and vitamin supplements (74%), which was significantly above use of the next most frequent CAM, massage therapy (6%). Most pharmacists (71%) reported offering CAM products for sale; however, 27% of these practices did not have access to CAM information for pharmacy staff or patients. Pharmacists generally viewed CAM positively and believed that they enhanced the customers' image of pharmacy (57%), increased customer numbers (87%), and could increase annual sales (72%). Ninety-one percent of respondents believed that it is necessary for pharmacists to have knowledge of both CAM and conventional medicine to be able to inform patients about their treatment options. Books and journal articles were their primary information sources, with the main reasons for recommending CAM evidence of efficacy and to maintain general health.

CONCLUSIONS

CAM use is prevalent among Australian pharmacists. While pharmacists are aware of their role as educators about both CAM and conventional medicines, there is a need for greater access to CAM resources and education on these therapies.

Psicologia e acupuntura: primeiras aproximações

Trata-se de um estudo teórico buscando identificar as possibilidades de utilização da prática da acupuntura pelos psicólogos, haja vista a Resolução nº05/02, do Conselho Federal de Psicologia, que aponta tal técnica como um instrumento do profissional de Psicologia. O trabalho apresenta os principais conceitos que embasam a acupuntura, considerando a sua inserção na medicina tradicional chinesa e na filosofia taoísta, além de fazer uma revisão acurada dos trabalhos científicos que vêm sendo produzidos em diferentes países, oportunizando estudos que mostram a pertinência do conhecimento da acupuntura no tratamento das patologias mentais.

Trends in Complementary and Alternative Medicine in Eastern Turkey

OBJECTIVE

To investigate the types and prevalence of complementary and alternative medicine (CAM) use among adults in eastern Turkey and to evaluate the relationship between the use of CAM and sociodemographic characteristics.

DESIGN

This study was a random-sampled survey examining patterns of use of complementary therapies in two university hospitals in the Eastern Anatolia region of Turkey.

SETTING AND SUBJECTS

Seven-hundred-fourteen (714) adult participants were interviewed at two sites: two university hospitals both located in Erzurum. Subjects were excluded if they did not speak Turkish because this may sometimes cause communication problems between patients and health care professionals. Patients younger than 18 years old and those residing outside of the eastern region of Turkey were not included in this study.

MEASUREMENT

Use of CAM within the previous year.

RESULTS

Seventy percent (70%) of participants reported the use of CAM. Herbs (41%) were the most frequently cited therapies. Although 87% of the subjects reported that they were satisfied with their use of CAM, the majority (84.8%) did not discuss the use of these therapies with their primary physicians.

CONCLUSIONS

This study revealed that there is a high prevalence of use of alternative therapies by individuals living in eastern Turkey.