Use of complementary and alternative medicine in patients with health complaints attributed to former dental amalgam fillings

Validity and responsiveness of EQ-5D-5L and SF-6D in patients with health complaints attributed to their amalgam fillings: a prospective cohort study of patients undergoing amalgam removal

Background

Evidence of health utility changes in patients who suffer from longstanding health complaints attributed to dental amalgam fillings are limited. The change in health utility outcomes enables calculating quality-adjusted life-year (QALY) and facilitates the comparison with other health conditions. The purpose of this study was to estimate the validity and responsiveness of the EQ-5D-5L and SF-6D utilities following removal of dental amalgam fillings in patients with health complaints attributed to their amalgam fillings, and examine the ability of these instruments to detect minimally important changes over time.

Methods

Patients with medically unexplained physical symptoms, which they attributed to dental amalgam restorations, were recruited to a prospective cohort study in Norway. Two health state utility instruments, EQ-5D-5L and SF-6D, as well as self-reported general health complaints (GHC-index) and visual analogue scale (EQ-VAS) were administered to all patients (n = 32) at baseline and at follow-up. The last two were used as criteria measures. Concurrent and predictive validities were examined using correlation coefficients. Responsiveness was assessed by the effect size (ES), standardized response mean (SRM), and relative efficiency. Minimally important change (MIC) was examined by distribution and anchor-based approaches.

Results

Concurrent validity of the EQ-5D-5L was similar to that of SF-6D utility. EQ-5D-5L was more responsive than SF-6D: the ES were 0.73 and 0.58 for EQ-5D-5L and SF-6D, respectively; SRM were 0.76 and 0.67, respectively. EQ-5D-5L was more efficient than SF-6D in detecting changes, but both were less efficient compared to criteria-based measures. The estimated MIC of EQ-5D-5L value set was 0.108 and 0.118 based on distribution and anchor-based approaches, respectively. The corresponding values for SF-6D were 0.048 and 0.064, respectively.

Conclusions

In patients with health complaints attributed to dental amalgam undergoing amalgam removal, both EQ-5D-5L and SF-6D showed reasonable concurrent and predictive validity and acceptable responsiveness. The EQ-5D-5L utility appears to be more responsive compared to SF-6D.

Trial registration The research was registered at ClinicalTrials.gov., NCT01682278. Registered 10 September 2012, https://clinicaltrials.gov/ct2/show/NCT01682278.

A systematic review of the evidence base for the Lightning Process

BACKGROUND

The Lightning Process (LP), a mind-body training programme, has been applied to a range of health problems and disorders. Studies and surveys report a range of outcomes creating a lack of clarity about the efficacy of the intervention.

OBJECTIVE

This systematic review evaluates the methodological quality of existing studies on the LP and collates and reviews its reported efficacy.

DATA SOURCES

Five databases, PsycINFO, PubMed, CINAHL, Embase, ERIC (to September 2018), and Google and Google Scholar were searched for relevant studies.

STUDY SELECTION

Studies of the LP in clinical populations published in peer-reviewed journals or in grey literature were selected. Reviews, editorial articles and studies/surveys with un-reported methodology were excluded.

DATA EXTRACTION

Searches returned 568 records, 21 were retrieved in full text of which 14 fulfilled the inclusion criteria (ten quantitative studies/surveys and four qualitative studies).

DATA SYNTHESIS AND CONCLUSIONS

The review identified variance in the quality of studies across time; earlier studies demonstrated a lack of control groups, a lack of clarity of aspects of the methodology and potential sampling bias. Although it found a variance in reported patient outcomes, the review also identified an emerging body of evidence supporting the efficacy of the LP for many participants with fatigue, physical function, pain, anxiety and depression. It concludes that there is a need for more randomised controlled trials to evaluate if these positive outcomes can be replicated and generalised to larger populations.

Use of traditional and complementary medicine among Norwegian cancer patients in the seventh survey of the Tromsø study

Background

Traditional and complementary medicine (T&CM) is commonly used by cancer patients in Northern Norway, in particular spiritual forms like traditional healing. T&CM is mainly used complementary to conventional cancer treatment and is rarely discussed with conventional health care providers, increasing the risk of negative interaction with conventional cancer care. The aim of this study was to investigate the use of T&CM among cancer patients in Tromsø, and to investigate the differences in T&CM use between people living with cancer, people with cancer previously, and people without a history of cancer.

Method

Data was drawn from the seventh survey of the Tromsø study conducted in 2015–2016. All inhabitants of Tromsø aged 40 and above were invited to participate (n = 32,591) of whom n = 21,083 accepted the invitation (response rate 65%). Data was collected thorough three self-administered questionnaires and a comprehensive clinical examination. Pearson chi-square tests, Fisher exact tests and one-way ANOVA tests were used to describe differences between the groups while binary logistic regressions were used for adjusted values.

Results

Eight percent of the participants (n = 1636) reported to have (n = 404) or have had (n = 1232) cancer. Of the participants with cancer at present 33.4% reported use of T&CM within the last year, 13.6% had consulted a T&CM provider, 17.9% had used herbal medicine/natural remedies and 6.4% had practiced self-help techniques. The participants with cancer at present were more likely to have visited a T&CM provider than participants with cancer previously (13.6% vs. 8.7%, p = 0.020). Among the participants with cancer at present, 6.4% reported to have consulted a TM provider, 5.8% had consulted an acupuncturist, while 4.7% had consulted other CM providers. Women were significantly more likely than men to have used acupuncture and self-help techniques. No significant gender differences were found regarding visits to other CM providers, TM providers nor use of herbal medicine/natural remedies.

Conclusion

The findings are in line with previous research suggesting that both men and women use TM complementary to other CM modalities outside the official health care system. As herbal medicine might interact with conventional cancer treatment, health care providers need to discuss such use with their patients.

Prevalence, and health- and sociodemographic associations for visits to traditional and complementary medical providers in the seventh survey of the Tromsø study

Background

Patient-centered culturally sensitive health care (PC-CSHC) has emerged as a primary approach to health care. This care focuses on the cultural diversity of the patients rather than the views of the health care professionals. PC-CSHC enables the patient to feel comfortable, respected, and trusted in the health care delivery process. As users of traditional and complementary medicine (T&CM) rarely inform their conventional health care providers of such use, the providers need to identify the users of T&CM themselves to avoid negative interaction with conventional medicine and to be able to provide them with PC-CSHC. Since the patterns of traditional medicine (TM) use are different to those of complementary medicine (CM), the aim of this study was to investigate the prevalence, and the health- and sociodemographic associations for visits to TM- and CM providers in an urban population.

Method

The data were collected through two self-administrated questionnaires from the seventh survey of the Tromsø Study, a population-based cohort study conducted in 2015–2016. All inhabitants of Tromsø aged 40 or above were invited (n = 32,591) and n = 21,083 accepted the invitation (response rate 65%). Pearson chi-square tests and one-way ANOVA tests were used to describe differences between the groups whereas binary logistic regressions were used for adjusted values.

Results

The results revealed that 2.5% of the participants had seen a TM provider, 8.5% had seen a CM provider whereas 1% had visited both a TM and a CM provider during a 12-month period. TM users tended to be older, claim that religion was more important to them, have poorer economy and health, and have lower education compared to CM users. We found that more than 90% of the participants visiting T&CM providers also used conventional medicine.

Conclusion

A considerable number of the participants in this study employed parallel health care modalities including visits to conventional, traditional, and complementary medicine providers. To offer patient-centered culturally sensitive health care that is tailored to the patients’ treatment philosophy and spiritual needs, conventional health care providers need knowledge about, and respect for their patients’ use of parallel health care systems.

Self-Reported Effects of Energy Healing: A Prospective Observational Study With Pre-Post Design

INTRODUCTION

Healing is reported to be used by 16.8% of the population, however utilization may be considerably higher in selected patient groups. The aim of this study was to map the symptoms the participants reported when visiting a healer for the first time, and to evaluate the subjectively experienced benefits and risks from the healing sessions.

METHOD

Data were obtained from the Measure Yourself Medical Outcome Profile (MYMOP) questionnaire. One-hundred adults who, for the first time, referred themselves to a healer in southern Norway between January 2016 and January 2017 were included in the study. Eligible for analyses were 92 participants who fulfilled their treatment plan and returned both the baseline (pre) and post-treatment questionnaire. The occurring symptoms were grouped according to their nature into four symptom groups: pain, psychological problems, fatigue and other. With regard to the observational character of the study, all results were described and interpreted descriptively and exact p-values were given and interpreted as measures of effect.

RESULTS

The participants who visited the healers in this study were mainly women (80%) with chronic disease (82%), with pain, fatigue and/or psychological problems as main complaints. They experienced an improvement of symptoms, well-being and improved activity level of approximately 50% regardless of the nature of the complaints. Women reported more improvement than men did. The pre-post changes was found after an average of 4.1 treatments. Forty percent of the participants reported adverse effects, which occurred directly after the healing session, generally lasting for less than one day.

CONCLUSION

The study participants reported substantial improvement of, and major reduction of the burden of symptoms, improved well-being and activity level after healing sessions. Due to the observational nature of the study, no interpretations about specificity of the descriptive results or the mechanisms of effect can be made.

Health Complaints Attributed to Dental Amalgam: A Retrospective Survey Exploring Perceived Health Changes Related to Amalgam Removal

BACKGROUND

Many patients have complex health complaints they attribute to dental amalgam. There is some evidence of symptom relief after removal of amalgam.

OBJECTIVE

The aims of this study were to assess the total symptom load in patients with all their amalgam fillings removed, and to investigate the self-reported improvement of health with regard to precautions taken under amalgam removal and time since removal.

METHODS

The survey was distributed to all members (n=999) of the Norwegian Dental patients association in 2011. The study participants returned the questionnaires anonymously by means of a pre-stamped envelope. The questionnaire asked for sociodemographic data, subjectively perceived health status, complaints persisting after amalgam removal and self-reported changes in symptoms after amalgam removal.

RESULTS

A total of 324 participants were included in the study. The majority of the participants reported improved health after amalgam removal, even though the mean degree of severity of complaints was still high. Exhaustion and musculoskeletal complaints were most severe, and reflects the fact that 38% of the participants reported poor to very poor current health. With regard to amalgam removal, associations between improved health, number of precautions applied, and time since removal were found.

CONCLUSION

Most of the participants in this study reported improvement of health after amalgam removal even though they still suffered a high complaint load. Since absolute symptom load is a robust predictor for general health outcome and socioeconomic burden for society, a possible intervention, which enables patients to further improve their health status is desirable.

"Struggle to obtain redress": Women's experiences of living with symptoms attributed to dental restorative materials and/or electromagnetic fields

The aim of this study was to explore the experiences of illness and the encounters with health care professionals among women who attributed their symptoms and illness to either dental restorative materials and/or electromagnetic fields, despite the fact that research on health effects from dental fillings or electricity has failed to substantiate the reported symptoms. Thirteen women (aged 37-63 years) were invited to the study and a qualitative approach was chosen as the study design, and data were collected using semi-structured interviews. The analysis was conducted with a constant comparative method, according to Grounded Theory. The analysis of the results can be described with the core category, "Struggle to obtain redress," the two categories, "Stricken with illness" and "A blot in the protocol," and five subcategories. The core category represents the women's fight for approval and arose in the conflict between their experience of developing a severe illness and the doctors' or dentists' rejection of the symptoms as a disease, which made the women feel like malingerers. The informants experienced better support and confirmation from alternative medicine practitioners. However, sick-leave certificates from alternative medicine practitioners were not approved and this led to a continuous cycle of visits in the health care system. To avoid conflicting encounters, it is important for caregivers to listen to the patient's explanatory models and experience of illness, even if a medical answer cannot be given.