Turkish general practitioners and complementary/alternative medicine

Knowledge, attitude, perceived effectiveness and self-practice of complementary and alternative medicine: a cross-sectional comparison between medical and non-medical students of Bangladesh

BACKGROUND

Bangladesh's population commonly utilizes Complementary and alternative medicine (CAM) to treat their health issues. Despite the increasing interest in CAM, it has been excluded from conventional medical training in Bangladesh for many years. Therefore, this study assessed and compared the knowledge level, attitude, perceived effectiveness, and self-practice of CAM among undergraduate students of Bangladesh.

METHODS

This cross-sectional group comparison study was conducted among undergraduate (both medical and non-medical) students of Bangladesh between November and December 2021. Data was collected using a self-reported pretested semi-structured online questionnaire. The questionnaire contained questions regarding background information, knowledge regarding CAM, source of CAM knowledge, attitude towards CAM, interest in attaining CAM knowledge, perceived effectiveness of CAM, perceived adverse effects of CAM, self-practice of CAM, and whether would they refer CAM to others. A total of 576 students responded and the data gathered allowed for the following: (1) an overview of the study groups, (2) respondents' general perception and knowledge regarding CAM, and (3) a comparison of respondents' CAM knowledge, general perception, and usage by area of study. Data were analyzed using STATA (v.16) and descriptive statistics, Pearson's chi-square test, and Mann-Whitney U test were performed.

RESULTS

A total of 329 medical students and 247 non-medical students participated in the study. The mean age of the participants was 21.57 ± 1.8 years and 56.2% of them were male. The most known CAM among medical (M) students was homeopathy (44.6%) and among non-medical (NM) students were herbal medicine (45.7%). Non-medical students had significantly better knowledge about nine out of twelve CAM modalities included in the study, and no significant differences were present for the rest of the modalities. Medical (81.1%) and non-medical students (86.2%) perceived traditional Chinese medicine and homeopathy to be the most effective respectively. "Incorporating CAM with conventional medicine would result in increased patient satisfaction" showed the most statistically significant (p = 0.0002) difference among both groups. Yoga was the most often practiced modality among medical students and homeopathy among non-medical students.

CONCLUSION

Medical students have a lacking of knowledge and a positive attitude towards CAM, despite its very common practice among the people of Bangladesh. Therefore, emphasis should be put on the inclusion of CAM modules in medical training.

Complementary and alternative medicines chosen for specific health problems: Internet survey using the I-CAM-Q in Japan: A STROBE-compliant cross-sectional study

This study investigated the different complementary and alternative medicines (CAMs) adopted by people in Japan, as well as the health problems treated with CAMs. Understanding more about this topic will facilitate the appropriate incorporation of CAMs into conventional medicine when treating health problems. Data were collected through an online survey based on the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). The study examined CAM utilization among people aged 20 years or older; 164 valid responses were collected (18.9%). We adopted a cross-sectional design. We then compared the relationships between the specific health problems reported by participants, their self-help practices, and the kinds of healthcare specialists consulted. We also examined participants' reasons for using CAMs and their responses regarding the usefulness of the CAMs adopted. We found that self-help/CAM practices differed for specific health problems. Participants with musculoskeletal and heart problems were more likely to use poultices. Those with respiratory and digestive problems were more likely to practice yoga, tai chi, and qigong. Those with digestive and neurological problems were more likely to use aromatherapy. The I-CAM-Q questionnaire also revealed the purpose and usefulness of the CAMs utilized as well as the participants' attitudes regarding conventional medicine. The study showed that participants find physicians less helpful than other options for treating their health problems. Additionally, when asked whether it was helpful to consult with a specific professional for health problems, there was a higher percentage of participants who answered "Very helpful" for professionals, like massage, judo, acupuncture, and moxibustion therapists, than for physicians. The results of this study will help to inform medical providers of the most appropriate types of CAMs for dealing with various health problems.

Survey of use of herbal and home remedies for hair and scalp among women in North West Saudi Arabia

Herbal products and home remedies, especially those used as cosmetics, are widely used worldwide. Therefore, we conducted this study to discover the pattern of use of remedies in treating hair and scalp disorders in Tabuk, North West area of Saudi Arabia. A survey about use of herbal products and home remedies was prepared to evaluate their in hair and scalp. The questionnaire was distributed to 149 female hairdressers, hair products sellers and traditional healers as well as female customers in these places. We found about forty-one plants and eleven home remedies used for hair and scalp in Tabuk area. The most widely used plants were Henna (15.01%), coconut (10.22%) and olive (8.14%). They were widely used in hair damage (32.01%), hair endings (21.95%) and hair loss (21.94%). In parallel, the most widely used home remedies were yogurt (32.42%), eggs (26.91%) and honey (23.85%). They were widely used in hair damage (45.57%), hair endings (26.91%) and hair loss (19.88%). There were no differences between participants in the pattern of use of remedies regarding their education level of age group. In conclusion, many natural herbal medicine and home remedies are still in use in North West region of Saudi Arabia for hair and scalp. There is a great shortage in medical sources of information. Finally, many of used remedies lacks important scientific information about their usage and safety.

European Union Project 'BestCARE': improving nursing care with best complementary therapy strategies

AIM

This paper introduces the study on the European Union Project on complementary therapies and discusses project outputs and results. The goal of the European Union Project was to improve the professional knowledge and skills of women's health and oncology nurses regarding CT.

BACKGROUND

The increasing and widespread use of complementary therapies in the women's health and oncology population requires nurses to be educated about their suitable and safe use. Many nurses do not have proper training in complementary therapies and therefore should not inform their patients about them.

METHODS

The 'Improving the Nursing Care with Best Complementary Therapy Strategies Based on European Union Standards' (BestCARE) project was a strategic partnership within Erasmus plus for vocational education and training. The BestCARE project was coordinated by the Akdeniz University Nursing Faculty and was carried out with six partners from Turkey and Europe.

RESULTS

Fifteen nurses from Turkey and Italy were trained in complementary therapies in England. In addition, training courses and seminars were held in Turkey and Italy for women's health and oncology nurses. The BestCARE programme consisted of 14 work packages. The BestCARE programme was implemented via websites, an e-learning training programme, training videos, reference and handbook, a curriculum proposal on complementary therapies and a simulation laboratory.

CONCLUSION AND IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY

The BestCARE project allowed nurses to gain knowledge, experience and skills about complementary therapies and created a cultural awareness and sensitivity towards patients, caregivers and health professionals.

Experiences of complementary and alternative medicine in patients with inflammatory bowel disease - a qualitative study

Background

The use of Complementary and Alternative Medicine (CAM) in Inflammatory Bowel Disease (IBD) is increasing. Although CAM often improves patients’ well-being, it can also lead to side-effects and interactions with conventional medications. Research on patients with IBD in Sweden who have experiences of CAM is sparse. More studies are needed to enhance awareness of and improve communication about CAM. The aim of this study was to describe experiences of CAM in the healthcare context reported by patients with IBD.

Methods

Fifteen patients with IBD, eight with Crohn’s disease (CD) and seven with ulcerative colitis (UC), were recruited. Semi-structured qualitative interviews were conducted and qualitative content analysis was performed.

Results

The analysis revealed the theme Knowledge and communication lead to participation in the area of CAM based on three categories; CAM use, Communication and Self-care. Patients with IBD wanted to be asked about CAM to be able to start a dialogue, as some perceived being treated in a disparaging manner and not taken seriously when raising the subject. Healthcare professionals (HCPs) need to be aware of this in order to meet and understand patient needs. Patients with IBD found it easier to communicate about CAM with the IBD nurses than physicians and dietary changes was one important CAM treatment.

Conclusions

The finding that it was easier to discuss CAM with nurses than physicians emphasizes the important role of the IBD nurse in communication and monitoring patients’ CAM use. Patients wanted to be asked about CAM to be able to start a dialogue, as some perceived not taken seriously when raising the subject. Furthermore, HCPs need to understand that many patients with IBD regard dietary changes as an important part of CAM treatment. Further research in these areas is needed.

Self-reported knowledge and approaches toward complementary and alternative medicine among physicians dealing with allergic diseases

Considering the popularity of Complementary and Alternative Medicine (CAM) in allergic patients, physicians involved in allergic patients' care need to be aware of CAM. To assess self-reported knowledge, attitude and approach to CAM of physicians who deal with allergic patients, a total of 500 structured questionnaires were distributed to physicians who participated in "Turkish National Society of Allergy and Clinical Immunology Congress-2009". For the questionnaires handed out, 242 (48.4%) physicians (median age 36.0 years, range 25-64 years) responded; 22.4% were fellows in training and 48.5% were residents. The main specialties were pediatrics (49.3%), and pulmonology (36.8%); half were either specialists or training in allergy and one-quarter (25.6%) referred patients to CAM. Asthma (42.1%) and chronic urticaria (28.9%) were the most common CAM referral diseases. Referred therapies were herbal (10.3%) and diet-based medicine (7.4%). The differences between physicians in terms of age, gender, experience in medicine, and specialty/allergy subspecialty were not statistically significant (p = 0.01). Affiliation to a university hospital was significantly associated with no CAM referral vs. affiliation in a state/private hospital or private practice. Academic degree and reported level of knowledge negatively/positively affected attitudes toward CAM, respectively. More than half of the respondents (68.8%) reported lack of or insufficient information about CAM, while 58.7% of physicians desired CAM education. This first report on physicians involved in allergic patients' care shows that they are reluctant to refer for CAM therapies. A minority believes that they have enough knowledge, and most are interested in continuing medical education on CAM. Considering physicians' interest and tendency to communicate significantly with their patients about CAM when they feel that they have sufficient knowledge and popularity of CAM among patients, training possibilities should be created to improve physicians' education in this field.

Knowledge and attitudes towards complementary and alternative medicine among medical students in Turkey

Objective

This study aims to examine knowledge and attitudes towards Complementary and Alternative Medicine among medical students in Turkey, and find out whether they want to be trained in Complementary and Alternative Medicine (CAM).

Methods

A cross-sectional study was carried out between October and December 2010 among medical students. Data were collected from a total of seven medical schools.

Findings

The study included 943 medical students. The most well known methods among the students were herbal treatment (81.2 %), acupuncture (80.8 %), hypnosis (78.8 %), body-based practices including massage (77 %) and meditation (65.2 %), respectively. Acupuncture, aromatherapy, herbal treatment and meditation were better known among female participants compared to males (p < 0.05). Females and first year students, generally had more positive attitudes. A larger proportion of female students compared to male students reported that a doctor should be knowledgeable about CAM (p = 0.001), and this knowledge would be helpful in their future professional lives (p = 0.015). Positive attitudes towards and willingness to receive training declined as the number of years spent in the faculty of medicine increased.

Conclusions

Majority of the medical students were familiar with the CAM methods widely used in Turkey, while most of them had positive attitudes towards CAM as well as willingness to receive training on the subject, and they were likely to recommend CAM methods to their patients in their future professional lives. With its gradual scientific development and increasing popularity, there appears a need for a coordinated policy in integrating CAM into the medical curriculum, by taking expectations of and feedback from medical students into consideration in setting educational standards.

An overview of the evidence and mechanisms of herb-drug interactions

Despite the lack of sufficient information on the safety of herbal products, their use as alternative and/or complementary medicine is globally popular. There is also an increasing interest in medicinal herbs as precursor for pharmacological actives. Of serious concern is the concurrent consumption of herbal products and conventional drugs. Herb-drug interaction (HDI) is the single most important clinical consequence of this practice. Using a structured assessment procedure, the evidence of HDI presents with varying degree of clinical significance. While the potential for HDI for a number of herbal products is inferred from non-human studies, certain HDIs are well established through human studies and documented case reports. Various mechanisms of pharmacokinetic HDI have been identified and include the alteration in the gastrointestinal functions with consequent effects on drug absorption; induction and inhibition of metabolic enzymes and transport proteins; and alteration of renal excretion of drugs and their metabolites. Due to the intrinsic pharmacologic properties of phytochemicals, pharmacodynamic HDIs are also known to occur. The effects could be synergistic, additive, and/or antagonistic. Poor reporting on the part of patients and the inability to promptly identify HDI by health providers are identified as major factors limiting the extensive compilation of clinically relevant HDIs. A general overview and the significance of pharmacokinetic and pharmacodynamic HDI are provided, detailing basic mechanism, and nature of evidence available. An increased level of awareness of HDI is necessary among health professionals and drug discovery scientists. With the increasing number of plant-sourced pharmacological actives, the potential for HDI should always be assessed in the non-clinical safety assessment phase of drug development process. More clinically relevant research is also required in this area as current information on HDI is insufficient for clinical applications.

Attitude of conventional and CAM physicians toward CAM in India

OBJECTIVES

The aim of the present study was to compare the attitude toward complementary and alternative medicine (CAM) of primary care physicians trained in conventional medicine with CAM physicians whose training was for a comparable duration. The CAM physicians included practitioners of Ayurveda, homeopathy, and naturopathy.

PARTICIPANTS

Two hundred and ninety five (295) physicians with aged 20-60 (group mean±standard deviation, 48.2-12.3 years, 87 females) participated. Eighty-six (86) of them were trained in Ayurveda, 90 in homeopathy, 82 in conventional medicine, and 37 in naturopathy. They were attending a 4-day residential program on Indian culture. All of them gave their signed consent to take part in the study, and the institution's ethics committee approved the study.

STUDY DESIGN

The study was a cross-sectional survey. Since the participants had self-selected to join for the program on Indian culture, the sampling could be considered as convenience sampling.

RESULTS

The number of conventionally trained and CAM physicians were similar in number and in their reasons for selecting CAM treatments.

CONCLUSIONS

Conventionally trained and CAM physicians were comparably likely to prescribe CAM treatments for their patients. Their reasons for prescribing CAM treatments appeared to be (1) the idea that CAM treatments deal with the cause, and (2) a belief in the treatments. A limiting factor of the survey is that it did not determine whether the belief was based on evidence or on faith alone.

Complementary and Alternative Medicine: Comparison of Current Knowledge, Attitudes and Interest among German Medical Students and Doctors

Although it has been agreed that complementary and alternative medicine (CAM) should be included in the German medical curriculum, there is no consensus on which methods and how it should be taught. This study aimed to assess needs for CAM education by evaluating current knowledge, attitudes and interests of medical students, general physicians and gynecologists. Two instruments based on established and validated questionnaires were developed. One was given to seventh semester medical students and the other to office-based doctors. Data were analyzed by bivariate correlation and cross-tabulation. Altogether 550 questionnaires were distributed-280 to doctors and 270 to medical students. Completed questionnaires were returned by 80.4% of students and 78.2% of doctors. Although 73.8% (160/219) of doctors and 40% (87/217) of students had already informed themselves about CAM, neither group felt that they knew much about CAM. Doctors believed that CAM was most useful in general medicine, supportive oncology, pediatrics, dermatology and gynecology, while students believed that dermatology, general medicine, psychiatry and rheumatology offered opportunities; both recommended that CAM should be taught in these areas. Both groups believed that CAM should be included in medical education; however, they believed that CAM needed more investigation and should be taught "critically". German doctors and students would like to be better informed about CAM. An approach which teaches fundamental competences to students, chooses specific content based on evidence, demographics and medical conditions and provides students with the skills they need for future learning should be adopted.

Complementary and alternative medicine use among people with diabetes in Turkey

The aim of this study was to investigate use of complementary and alternative medicines, and factors that affect use of these agents, in individuals with diabetes. This cross-sectional and descriptive study was performed at the outpatient clinics of four hospitals in Turkey with 396 diabetic individuals between October 2006 and March 2007. In this study, 34.6% of the participants were using complementary and alternative medicine in addition to conventional medicine; 73% of these individuals had not informed their doctors and nurses about their complementary and alternative medicine practice. Nurses, as health care providers, should not ignore complementary and alternative medicine options. Instead, they should try to determine the rate of complementary and alternative medicine use among their patients and understand their effects and the reasons for use of these agents. Nurses should learn more about these medicines and educate their patients.

Integration of complementary and alternative medicine into family practices in Germany: results of a national survey

More than two-thirds of patients in Germany use complementary and alternative medicine (CAM) provided either by physicians or non-medical practitioners ("Heilpraktiker"). There is little information about the number of family physicians (FPs) providing CAM. Given the widespread public interest in the use of CAM, this study aimed to ascertain the use of and attitude toward CAM among FPs in Germany. A postal questionnaire developed based on qualitatively derived data was sent to 3000 randomly selected FPs in Germany. A reminder letter including a postcard (containing a single question about CAM use in practice and reasons for non-particpation in the survey) was sent to all FPs who had not returned the questionnaire. Of the 3000 FPs, 1027 (34%) returned the questionnaire and 444 (15%) returned the postcard. Altogether, 886 of the 1471 responding FPs (60%) reported using CAM in their practice. A positive attitude toward CAM was indicated by 503 FPs (55%), a rather negative attitude by 127 FPs (14%). Chirotherapy, relaxation and neural therapy were rated as most beneficial CAM therapies by FPs, whereas neural therapy, phytotherapy and acupuncture were the most commonly used therapies in German family practices. This survey clearly demonstrates that CAM is highly valued by many FPs and is already making a substantial contribution to first-contact primary care in Germany. Therefore, education and research about CAM should be increased. Furthermore, with the provision of CAM by FPs, the role of non-medical CAM practitioners within the German healthcare system is to be questioned.

Use of complementary and alternative medicines by a sample of Turkish women for infertility enhancement: a descriptive study

Background

Infertility patients are a vulnerable group that often seeks a non-medical solution for their failure to conceive. World-wide, women use CAM for productive health, but only a limited number of studies report on CAM use to enhance fertility. Little is known about traditional and religious forms of therapies that are used in relation to conventional medicine in Turkey. We investigated the prevalence and types of complementary and alternative medicine (CAM) used by infertile Turkish women for fertility enhancement.

Methods

A face-to-face questionnaire inquiring demographic information and types of CAM used for fertility enhancement were completed by hundred infertility patients admitted to a primary care family planning centre in Van, Turkey between January and July 2009.

Results

The vast majority of infertile women had used CAM at least once for infertility. CAM use included religious interventions, herbal products and recommendations of traditional "hodja's" (faith healers). Of these women, 87.8% were abused in the last 12 months, 36.6% felt not being supported by her partner and 80.5% had never spoken with a physician about CAM.

Conclusions

Infertile Turkish women use complementary medicine frequently for fertility enhancement and are in need of information about CAM. Religious and traditional therapies are used as an adjunct to, rather than a substitute for, conventional medical therapy. Physicians need to approach fertility patients with sensitivity and should be able to council their patients about CAM accordingly.