Complementary Therapies in Medicine

Premenstrual syndrome (PMS) refers to a cyclic appearance of somatic and psychiatric symptoms that affect some women. Finding an effective and safe method for the treatment of PMS has always been a serious concern, because approximately 40% of women report PMS, and in 2-10% of cases it is severe enough to affect their life style and job. The purpose of the present study is to evaluate the effect of omega-3 fatty acids on the treatment of PMS. A randomized double blind controlled trial was performed on 184 eligible women. The eligible women were randomly assigned into two groups. The number of women who have finalized the study with us was 124. In the case group (omega-3 group=group A, n=70), omega-3 in an amount of 2g was prescribed for a one per day basis on a single dosage (two 1g pearls), and in the control group (placebo group=group B, n=69) 2 placebo soft gel, which were completely similar to omega-3 soft gels, were prescribed. The severity and duration of each of the symptoms were compared in both groups 1.5 and 3months after the beginning of treatment. There were no significant differences between the two groups according to age, BMI, level of education, and the severity and duration of primary symptoms. After 45days from starting omega-3, the mean severity of depression (P=0.03), anxiety (P=0.02), lack of concentration (P=0.03) and bloating (P=0.02) in the case group, were all significantly lower than in the control group. The duration of depression (P=0.04) and bloating (P=0.031) in the case group were less than in the control group. After 90days from starting the treatment, the mean severity of depression (P=0.007), anxiety (P=0.004), lack of concentration (P=0.009), bloating (P=0.004), nervousness (P=0.01) and the duration of depression (P=0.01), nervousness (P=0.02), anxiety (P=0.03), lack of concentration (P=0.02), bloating (P=0.004), headache (P=0.04) and breast tenderness (P=0.02) were all lower in the case group. It appears that omega-3 fatty acids may reduce the psychiatric symptoms of PMS including depression, nervousness, anxiety, and lack of concentration and may also reduce the somatic symptoms of PMS including bloating, headache and breast tenderness. These effects increased by longer duration of treatment.

To examine the prevalence and characteristics of women who self-prescribe complementary and alternative medicine (CAM) for back pain. A cross-sectional survey of a nationally-representative sample of women aged 60-65 years from the Australian Longitudinal Study on Women's Health (ALSWH). A significant number of women (75.2%, n=985) self-prescribed one or more CAM for back pain in the previous twelve months. Use of self-prescribed CAM for back pain was not associated with socio-economic status. The most common self-prescribed CAM used by women was supplements (n=776, 59.2%), vitamins/minerals (n=592, 45.2%), yoga/meditation (n=187, 14.3%), herbal medicines (n=172, 13.1%) and aromatherapy oils (n=112, 8.6%). Women who visited general practitioners (GPs) more than three times in the previous twelve months were 1.59 times (95% CI: 1.14, 2.22) more likely to self-prescribe CAM for back pain than those women who did not visit GPs. Women who visited a pharmacist three or more times in the previous twelve months were 2.90 times (95% CI: 1.65, 5.09) more likely to self-prescribe CAM for back pain than those women who did not visit a pharmacist. This study identifies substantial use of self-prescribed CAM by women for back pain regardless of their education, income or urban/rural residency. In order to ensure safe, effective practice it is important that all providing and managing health services for back pain sufferers remain mindful of patients' possible use of self-prescribed CAM.

To assess patterns of diagnosis, including concordance, and treatment within a clinical trial of traditional acupuncture for low back pain. In a pragmatic randomised controlled clinical trial, 148 patients with low back pain, of between 4 weeks and 12 months duration, were randomised to the offer of individualised acupuncture and received up to 10 treatments. Standardised diagnosis and treatment records were completed by practitioners for 148 patients. The diagnosis was based on three pre-defined low back pain syndromes. For a subgroup of patients, one of the six practitioners then independently re-examined the patients, blind to the original diagnosis. The diagnostic inter-rater reliability was assessed in terms of percentage congruent classifications and Cohen's Kappa. Structured interviews of practitioners established further details about practice styles. The most commonly diagnosed syndrome associated with low back pain was Qi and Blood Stagnation (88% of patients), followed by Kidney Deficiency (53%) and Bi Syndrome (28%), with more than one syndrome being identified for 65% of patients. For the subgroup examined twice, practitioner concordance was reasonable: between 47 and 80% of classifications were congruent, while Kappa values lay between 0 ("the same as chance") and 0.67 ("good"). Practitioners provided 1269 treatments in total, using 177 different acupuncture points. Most commonly used channels were Bladder and Gall Bladder, and the commonest points were BL-23 and the two lowest Huatuojiaji points. Auxiliary treatments were utilised by all practitioners to varying degrees. Diagnostic concordance among practitioners was reasonable, and clear themes emerged for treatment. Further research is required to develop a flexible trial protocol with scope for individualised treatment.

To determine the characteristics of yoga and meditation users and non-users amongst young and mid-aged Australian women. The research was conducted as part of the Australian Longitudinal Study on Women's Health (ALSWH) which was designed to investigate multiple factors affecting the health and well being of women over a 20-year period. The younger (28-33 years) (n=8885) and mid-aged (56-61 years) (n=10,324) cohorts of the ALSWH who completed Survey 5 in 2006 and 2007 respectively. Use of yoga. This study estimates that 35% of Australian women aged 28-33 and 27% of Australian women aged 56-61 use yoga or meditation. Younger women with back pain (OR=1.28; 95% CI: 1.08, 1.52) and allergies (OR=1.25; 95% CI: 1.06, 1.49) were more likely to use yoga or meditation, while younger women with migraines or headaches (OR=0.73; 95% CI: 0.62, 0.87) were less likely to use yoga or meditation. Mid-age women with low iron (OR=1.68; 95% CI: 1.29, 2.19) and bowel problems (OR=1.37; 95% CI: 1.13, 1.65) were more likely to use yoga or meditation, while mid age women with hypertension (OR=0.62; 95% CI: 0.52, 0.76) were less likely to use yoga or meditation. A large percentage of the female population are using yoga or meditation. Given that women who regularly use yoga or meditation positively associated with measures of mental and physical health, there is a need for further research to examine the experiences and potential benefits of these mind-body practices for women's health.

Objective: To assess changes in awareness of, use of, attitudes to, and opinions about complementary and alternative medicine (CAM) amongst residents of North East Scotland and to obtain details about CAM use from respondents. Study design: Population survey carried out in 1999, 6 years after the initial study. Postal survey to 800 people to examine eight CAMs; acupuncture, aromatherapy, chiropractic, herbalism, homeopathy, hypnotherapy, osteopathy, and reflexology. Results: A total of 432/800 (54%) responded, of whom 175 (41%) had used at least one type of CAM compared to 29% in 1993. Increases in use were statistically significant for aromatherapy (18% versus 9%), acupuncture (10% versus 6%) and reflexology (9% versus 3%). A greater proportion of 1999 respondents thought CAM should be available on the NHS but a smaller proportion of respondents had concerns about using CAM (25% in 1993 and 20% in 1999). Overall concerns about effectiveness of therapies had increased from 36 to 45%, but fewer individuals were concerned about the cost of therapy in the 1999 survey (52% in 1993 to 22% in 1999). A total of 175 individuals provided details about one CAM they had used. The self-reported primary reasons for using CAM were relief of pain due to headaches or musculoskeletal problems, and for relaxation and relief of stress. The majority of CAM was therapist administered (103/166) as opposed to a bought product. Effectiveness ratings were self-reported but overall 80/166 found CAM very effective and 62/166 partially effective. A total of 65% had consulted their GP about their health problem before using CAM, 59/157 indicated their GP knew they were using CAM and of these, 14 indicated their GP was administering the therapy. Conclusions: The study has provided further baseline data on which to assess trends in CAM use and highlighted issues for patients and the NHS about the use of CAM to relieve health problems. Results indicate a greater proportion of the population of North East Scotland are both aware of and using CAM to relieve health problems. More research into the implications for the NHS of concurrent use of CAM with conventional medicine is required.

A custom-made questionnaire was sent to all UK medical charities in 1999 and again in 2002. Its primary aim was to assess the commitment of these institutions towards funding research in complementary and alternative medicine (CAM). Sixty-two (1999) and 60 (2002) answers were received corresponding to response rates of 62% and 55%. The total CAM research funds have increased from pound 70,000 in 1999 to pound 412,755 in 2002. In terms of total research budgets, this amounts to 0.05% and 0.31%, respectively. The number of CAM research projects has increased but so has the number of charities who do not fund CAM research. We conclude from these data that CAM research funding by UK medical charities has increased. In relative terms it does, however, remain low and out of proportion to the prevalence of CAM use in the UK.

The purpose of this study is to examine the national prevalence of herb and dietary supplement usage among children and adolescents age 4-17 in the United States, and to identify population factors associated with usage. Weighted population estimates are derived from the 2007 National Health Interview Child Complementary and Alternative Medicine Supplement (sample n=9417). Wald chi-square tests are used to compare factors associated with herb and dietary supplement use. An estimated 2.9 million children and adolescents used herbs or dietary supplements in 2007. Pediatric herb and supplement use was more common among adolescents and non-Hispanic whites, and positively associated with parental education and household income. Children with activity limitations due to chronic health conditions, long-term prescription use, or relatively heavy use of physician services were also more likely to use herbal supplements. Echinacea and fish oil were most commonly used herbs and supplements. Children in the US appear to use herbs or dietary supplements at a much lower rate than adults. This analysis shows a pattern of moderate and appropriate herb and supplement use in the pediatric population.

Recommendations about the use of plant stanol/sterol esters have not been updated since 2001. There have been many developments in medicines for lipid-lowering since 2001. In this review, the use of margarines containing stanol or sterol esters, to lower LDL cholesterol is considered in the 2011 setting. Firstly, there is a brief overview of the effects of the stanols/sterols on LDL cholesterol, which shows that these agents have a modest ability to lower LDL cholesterol, and are not effective in all conditions. Secondly, the relevance of the stanols/sterols in 2010/1 is questioned, given they have not been shown to reduce clinical endpoints, and have no effects on HDL cholesterol or triglyceride levels. Finally, there is a section comparing the stanols/sterols with the present day prescription lipid lowering medicines. Prescription drugs (statins, ezetimibe, and niacin) have a much greater ability to lower LDL cholesterol than the stanol/sterol esters, and also increase levels of HDL cholesterol and decrease levels of triglycerides. The statins and niacin have been shown to reduce cardiovascular clinical endpoints. Except in borderline normo/hypercholesterolemia, prescription drugs should be preferred to stanol/sterol esters for lowering LDL cholesterol in 2011.

Introduction: The purpose of this workshop was to further explore the implications of the placebo effect for both research and clinical practice from a variety of angles with a group of selected experts. Method/approach: The use of placebos in both clinical practice and research was explored in depth from a historical, methodological, ethical, legal and cultural point of view. The current state of knowledge regarding the placebo effect was established, knowledge gaps were identified, and the implications for both clinical research and practice were discussed in depth. Key messages: • Placebos have been consciously used in clinical practice since the 18th century, but only emerged as a research topic in the western world in the second half of the 20th century. • The placebo response consists of the placebo effect plus the natural course of the disease, and is a meaningful part of all medical treatments. • A variety of not fully understood individual, context and cultural factors contribute to the placebo response and interact in a non-linear way with the specific effects of medicines. • The assessment of a therapeutic effect in placebo-controlled RCTs is often difficult due to a strong placebo response, e.g. in Central Nervous System (CNS) indications like major depression or in Irritable Bowel Syndrome. • Placebo effects occur, and can affect the validity and appropriateness of placebo controlled trials in conventional as well as Complementary and Alternative Medicine (CAM) research. • It may be impossible to fully disentangle the verum and sham effects of both CAM and conventional medical procedures such as for instance acupuncture and surgery. • Context/meaning effects, including doctor empathy, are highly relevant and under-researched in both conventional and complementary medicine. • The use of 'impure placebos' (non-indicated/ineffective medicines) in clinical practice may be common, but little reliable data is available due to complexities around the definition of impure placebos and underreporting. • The assumption that placebo effects do not occur in veterinary research is likely to be incorrect, e.g. owner empathy and vet expectations can affect outcomes. • Various innovative trial designs that better deal with the placebo issue are available, but only as partial solutions. • Patient treatment will benefit from better understanding and appropriately utilising meaning/context effects. Conclusions: There are many remaining knowledge gaps with regard to the placebo response. The evolving knowledge challenges the paradigm of the placebo controlled RCT as a gold standard for demonstrating benefit of treatments. There are a number of pointers towards alternative research designs and paradigms worthy of further exploration. The evolving knowledge can contribute to the further development of a 'meaning orientated' and patient centred healthcare system.

Studies show that medical staff in different countries have different attitudes toward traditional and complementary medicine. Therefore, the current study aimed to evaluate the knowledge, attitude and practice of complementary and traditional medicine by medical staff of Kashan, Iran. A cross-sectional study was performed. A total of 378 questionnaires were distributed among health care team members in Kashan University of Medical Sciences in 2012. The questionnaire was consisted of 5 questions regarding demographic characteristics and 12 questions on knowledge, attitude and practice of traditional and complementary medicine. Data were analyzed using descriptive statistics. In total, 309 questionnaires were returned and 302 questionnaires were analyzed. Among the participants, 60.9% were female. The mean age of subjects was 29.70±9.28 years. Totally, 88.4% of the participants had no previous education on complementary and traditional medicine, and 77.8% showed interest to learn in this area. Also, 57.6% of participants had the experience of personal use of complementary and traditional therapies. The commonly used methods were: herbal therapy, cupping and traditional bathing. Participants used traditional medicine mostly for digestive diseases, colds, migraine and headaches, skin disorders, losing weight, and diabetes. Moreover, 56% of participants had recommended complementary and traditional therapies to the others. Most of the participants had low level knowledge on complementary and traditional medicine, but expressed their interest to learn in this field. Therefore, training health care team members and especially nurses and doctors on the applications, benefits and side effects of complementary and traditional medicine is recommended.

To describe yoga practice and health characteristics of individuals who practice yoga, and to explore their beliefs regarding the effects of their yoga practice on their health. A cross-sectional design with anonymous online surveys. 4307 randomly selected individuals from 15 US Iyengar yoga studios (n=18,160), representing 41 states; 1087 individuals responded, with 1045 (24.3%) surveys completed. Freiberg Mindfulness Inventory, Mental Health Continuum (subjective well-being), Multi-factor Screener (diet), PROMIS sleep disturbance, fatigue, and social support, International Physical Activity Questionnaire. Age: 19-87 years (M=51.7±11.7), 84.2% female, 89.2% white, 87.4% well educated (≥bachelor's degree). Mean years of yoga practice=11.4 (±7.5). BMI=12.1-49.4 (M=23.1±3.9). Levels of obesity (4.9%), smoking (2%), and fruit and vegetable consumption (M=6.1±1.1) were favorable compared to national norms. 60% reported at least one chronic/serious health condition, yet most reported very good (46.3%) or excellent (38.8%) general health. Despite high levels of depression (24.8%), nearly all were moderately mentally healthy (55.2%) or flourishing (43.8%). Participants agreed yoga improved: energy (84.5%), happiness (86.5%), social relationships (67%), sleep (68.5%), and weight (57.3%), and beliefs did not differ substantially according to race or gender. The more they practiced yoga, whether in years or in amount of class or home practice, the higher their odds of believing yoga improved their health. Individuals who practice yoga are not free of health concerns, but most believe their health improved because of yoga. Yoga might be beneficial for a number of populations including elderly women and those with chronic health conditions.

With the increasing demand and usage of complementary/alternative medicine (CAM) by the general public, it is vital that healthcare professionals can make informed decisions when advising or referring their patients who wish to use CAM. Therefore they might benefit from advice by CAM-providers as to which treatment can be recommended for which condition. The primary aim of this survey was to determine which complementary therapies are believed by their respective representing professional organizations to be suited for which medical conditions. 223 questionnaires were sent out to CAM organizations representing a single CAM therapy. The respondents were asked to list the 15 conditions they felt benefited most from their CAM therapy, the 15 most important contra-indications, the typical costs of initial and any subsequent treatments and the average length of training required to become a fully qualified practitioner. The conditions and contra-indications quoted by responding CAM organizations were recorded and the top five of each were determined. Treatment costs and hours of training were expressed as ranges. Of the 223 questionnaires sent out, 66 were completed and returned. Taking undelivered questionnaires into account, the response rate was 34%. Two or more responses were received from CAM organizations representing twelve therapies: aromatherapy, Bach flower remedies, Bowen technique, chiropractic, homoeopathy, hypnotherapy, magnet therapy, massage, nutrition, reflexology, Reiki and yoga. The top seven common conditions deemed to benefit by all twelve therapies, in order of frequency, were: stress/anxiety, headaches/migraine, back pain, respiratory problems (including asthma), insomnia, cardiovascular problems and musculoskeletal problems. Aromatherapy, Bach flower remedies, hypnotherapy, massage, nutrition, reflexology, Reiki and yoga were all recommended as suitable treatments for stress/anxiety. Aromatherapy, Bowen technique, chiropractic, hypnotherapy, massage, nutrition, reflexology, Reiki and yoga were all recommended for headache/migraine. Bowen technique, chiropractic, magnet therapy, massage, reflexology and yoga were recommended for back pain. None of the therapies cost more than ł60 for an initial consultation and treatment. No obvious correlation between length of training and treatment cost was apparent. The recommendations by CAM organizations responding to this survey may provide guidance to health care professionals wishing to advise or refer patients interested in using CAM.

Phytic acid or IP6 has been extensively studied in animals and is being promoted as an anti-cancer agent in health food stores. It is naturally found in legumes, wheat bran, and soy foods. It is believed to be the active ingredient that gives these substances their cancer fighting abilities. Proposed mechanisms of action include gene alteration, enhanced immunity, and anti-oxidant properties. A Medline search from 1966 to May 2002 using the keywords phytic acid and cancer, and limiting the search to the subheadings of therapeutic uses, prevention, and adverse effects revealed 28 studies. These studies were included in the review. A great majority of the studies were done in animals and showed that phytic acid had anti-neoplastic properties in breast, colon, liver, leukemia, prostate, sarcomas, and skin cancer. There were no human studies. Side effects included chelation of multivalent cations, and an increase in bladder and renal papillomas. This increase in papilloma formation only occurred with the sodium salt of phytic acid. It did not occur with either the potassium or magnesium salts. There is a large body of animal evidence to show that phytic acid may have a role in both the prevention and treatment of many forms of cancer. There is clearly enough evidence to justify the initiation of Phase I and Phase II clinical trials in humans.

To assess, using a modelling approach, the effectiveness and costs of breech version with acupuncture-type interventions on BL67 (BVA-T), including moxibustion, compared to expectant management for women with a foetal breech presentation at 33 weeks gestation. A decision tree was developed to predict the number of caesarean sections prevented by BVA-T compared to expectant management to rectify breech presentation. The model accounted for external cephalic versions (ECV), treatment compliance, and costs for 10,000 simulated breech presentations at 33 weeks gestational age. Event rates were taken from Dutch population data and the international literature, and the relative effectiveness of BVA-T was based on a specific meta-analysis. Sensitivity analyses were conducted to evaluate the robustness of the results. We calculated percentages of breech presentations at term, caesarean sections, and costs from the third-party payer perspective. Odds ratios (OR) and cost differences of BVA-T versus expectant management were calculated. (Probabilistic) sensitivity analysis and expected value of perfect information analysis were performed. The simulated outcomes demonstrated 32% breech presentations after BVA-T versus 53% with expectant management (OR 0.61, 95% CI 0.43, 0.83). The percentage caesarean section was 37% after BVA-T versus 50% with expectant management (OR 0.73, 95% CI 0.59, 0.88). The mean cost-savings per woman was euro 451 (95% CI euro 109, euro 775; p=0.005) using moxibustion. Sensitivity analysis showed that if 16% or more of women offered moxibustion complied, it was more effective and less costly than expectant management. To prevent one caesarean section, 7 women had to use BVA-T. The expected value of perfect information from further research was euro0.32 per woman. The results suggest that offering BVA-T to women with a breech foetus at 33 weeks gestation reduces the number of breech presentations at term, thus reducing the number of caesarean sections, and is cost-effective compared to expectant management, including external cephalic version.

To describe prevalence rates of complementary and alternative medicine therapies (CAM) for the relief of menopausal complaints among German women. Furthermore, to investigate the perceived effectiveness of these therapies. A self-administered questionnaire was sent to 9785 randomly selected women in Germany aged between 45 and 60 years. A total of 1893 (19.3%) questionnaires have been sent back. The mean age of all participants was 52.6±4.3 years. 81% (n=1517) of the responding women stated that they had experienced menopausal complaints at least once. Symptoms ranged from vasomotor symptoms, including hot flushes and night sweats, in 71.2% of cases, to bladder problems in 42.7%. The average symptom score (MRS II total score, range 1-44) among the respondents was 12.76±9.6. More than half (56%; n=1049/1872) of the responding women had used some form of therapy to alleviate their symptoms at least once. The majority of women undertaking a therapy (64.8%; n=679/1049) had used only CAM interventions (either one or more type of CAM), 14.2% (n=149) had used hormone replacement therapy (HRT) only, while 21.1% (n=221/1049) had tried both CAM and HRT. Popular CAM interventions by the respondents were an alteration of lifestyle (28.7%), St. John's wort (18.3%) and homoeopathy (14.9%). An alteration in lifestyle was rated as the most effective CAM treatment with 84.9% (n=457). Other treatments like hormone yoga (79.2%; n=42), homoeopathy (73.7%; n=205) and TCM (59.1%; n=94) were also perceived to be effective. Phytoestrogens were rated as the most ineffective (45.5%; n=50). CAM interventions to alleviate menopausal complaints are popular among German women, with 48.2% (n=900/1872) of respondents reporting having used CAM either alone or in combination with HRT. However, the users rated the effects of CAM differently, with some reporting CAM to be highly effective, while others indicate lower effectiveness. Nevertheless, women with a significantly higher symptom scoring tend to use both CAM and a conventional therapy (HRT).

Many individuals who appear to suffer from incurable chronic skin disease use complementary and alternative medicine (CAM). Homeopathy has recently increased in popularity among patients with skin disease. The effects of homeopathic treatment have yet to be fully investigated in patients for whom conventional dermatological treatment is not sufficiently effective. To describe patient-reported and clinically observed effects of individualized homeopathic treatment of chronic skin disease. The effectiveness of individualized homeopathic treatment was measured using the patients' own assessments of seven elements (overall impression, improvement of skin condition, reduction of itchiness, reduction of sleep disturbance, satisfaction in daily life, fulfillment at work and satisfaction in human relations) using a nine-point scale similar to the Glasgow Homeopathic Hospital Outcome Scale (GHHOS). Sixty patients with chronic skin disease were included in the study: atopic dermatitis (AD) (n=25), eczema other than AD (n=20), severe acne (n=6), chronic urticaria (n=6), psoriasis vulgaris (n=2) and alopecia universalis (n=1). These patients received individualized homeopathic treatments in addition to conventional dermatological treatments for a period of from 3 months to 2 years 7 months. Six patients reported a score of 4 (complete recovery), 23 patients a score of 3 (75% improvement), 24 patients a score of 2 (50% improvement) and 7 patients a score of 1 (25% improvement). A total of 88.3% of patients reported over 50% improvement. Around one-half the patients with AD and eczema reported greater satisfaction in daily life, greater fulfillment at work and greater satisfaction in human relations. The psychological, physical and psychosomatic symptoms and effects of chronic skin diseases are inextricable. Individualized homeopathic treatment can provoke a good response in patients with chronic skin disease; therefore, the holistic approach used in homeopathy may be a useful strategy alongside conventional treatment.

To generate preliminary data on how individual reflexologists deal with patients seeking medical advice on the Internet. E-mail survey involving reflexologists who were partly blinded for their advice on the Internet. Cyberspace. Two hundred and seventy-seven members of the Association of Reflexologists. Of 842 e-mails sent out we received 323 responses (38% response rate) of which 46 participants later withdrew their responses (14% withdrawal rate). Participants were asked to advise a fictitious patient via e-mail who presented various health problems. Rating of responses according to safety and claims made by reflexologist sample. Eighty-five percent of all respondents advised the fictitious patient to present the health problems to a medical professional. Fifty-eight percent expressed urgency to see a primary care physician or other health care professional and 95% pointed out that a diagnosis cannot and should not be made by a reflexologist. Twenty-nine percent of responders suggested a differential diagnosis or underlying causes for the patient's condition. In this survey reflexologists from the UK Association of Reflexologists have responded in an encouraging manner to a fictitious patient's request for health advice via electronic mail as only 5% (or possibly 15%) of reflexologists from this survey need to be more cautious about the advice they give their patients. We hope that our study will further encourage therapists to be more cautious giving Internet health advice in the future.

The aim of this pilot study was to evaluate the effect of yoga exercises on pain frequency and intensity and on quality of life in children with functional abdominal pain. 20 children, aged 8-18 years, with irritable bowel syndrome (IBS) or functional abdominal pain (FAP) were enrolled and received 10 yoga lessons. Pain intensity and pain frequency were scored in a pain diary and quality of life was measured with the Kidscreen quality of life questionnaire (KQoL). In the 8-11 year old group and the 11-18 year old group pain frequency was significantly decreased at the end of therapy (p=0.031 and p=0.004) compared to baseline. In the 8-11 year group pain intensity was also significantly decreased at this time point (p=0.015). After 3 months there still was a significant decrease in pain frequency in the younger patient group (p=0.04) and a borderline significant decrease in pain frequency in the total group (p=0.052). Parents reported a significantly higher KQoL-score after yoga treatment. This pilot study suggests that yoga exercises are effective for children aged 8-18 years with FAP, resulting in significant reduction of pain intensity and frequency, especially in children of 8-11 years old.

To evaluate the depths to which acupuncture needles can be inserted safely (safe depth) in 12 abdominal acupoints in pediatric patients. This study also evaluates the variations in safe depth according to sex, age, body weight, and waist girth. We retrospectively studied computerized tomography (CT) images of pediatric patients aged 7-15 years who had undergone abdominal CT scans at our hospital from January 1997 to March 2006. The safe depth of 12 acupoints along the conception vessel (CV) meridian (Renmai), CV-2 to CV-7 and CV-9 to CV-14, were measured directly on the CT images. The relationship between the safe depth of these acupoints and sex, age, body weight and waist girth was analyzed by one-way ANOVA and multiple linear regression analysis. A total of 219 patients were included in this study. Except for CV-2, there was no significant difference in safe depth of the other 11 acupoints between sexes. The safe depth of all 12 CV acupoints increased significantly (P<0.001) with age, body weight and waist girth. There were large variations in the safe depth of the 12 points among different age and body weight groups. The safe depths were 1.3-2.1 times deeper in the 12-15-year-old group than in the 7-9-year-old group, and 1.7-3 times deeper in overweight children than in underweight children. The safe depth to which the 12 abdominal CV meridian acupoints can be needled significantly increases with age, body weight and waist girth in pediatric patients aged 7-15 years. Physicians who perform acupuncture in pediatric patients should be aware of the large variations in safe depth of acupoints to prevent possible complications.

This novel study provides a time series analysis of tongue features extracted from a diabetic patient with pyogenic liver abscess (PLA), treated with the integration of western medicine and traditional Chinese medicine (TCM). The features, namely, tongue color, tongue fur thickness and fur color, identified from a series of tongue images taken every two days, exhibit significant transitions matching closely with the progression of disease. These tongue features could serve as effective, non-intrusive indices for different progression stages of diabetes with PLA. A 76-year-old male diabetic patient was admitted for hyperglycemic hyperosmolar state. Intermittent fever and abdominal discomfort were noted. After performing abdominal computed tomography and laboratory studies, the results indicated pyeogenic liver abscess, Klebsiella pneumoniae ssp. pneumoniae related. As PLA progressed, the patient suffered spiking fever and right upper abdominal pain. Tongue examination revealed features with red tongue, white-yellow and thick fur. After receiving pigtail catheter drainage, the fever subsided and the pus-like fluid was drained smoothly. During the course of this process, gradually dwindled tongue fur witnessed through periodic tongue examination coincides consistently with laboratory data, namely, body temperature, fasting plasma glucose and plasma glucose level gathered. This is the first time series analysis of applying tongue examination to the progression of a specific disease. Through a series of tongue images taken periodically, tongue color, tongue fur thickness and fur color are identified to closely linked to the progression of diabetes with PLA, as indicated by data gathered through means of plasma glucose and abdominal sonographic follow-ups. Based on this promising finding, our future study will further extend the application of tongue assessment to evaluate the tongue characteristics of diabetic patients.

To examine whether spa resort use is associated with the health of Japanese employees. Cross-sectional survey. 3341 employees (2280 males and 1061 females) aged 20-65 in local government in Japan. The physical and mental component summary scores (PCS and MCS) of the Short Form 36 (SF-36), sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI), sickness leave (> or =7 days in the previous year), and hospital admission in the previous year. The PCS and MCS increased with the frequency of spa resort use in men and women. Less frequent use was associated with poor sleep quality for men and women and sickness leave for men. There was no significant relationship between use frequency and hospital admission. Spa resort use may have beneficial effects on physical and particularly mental health. Longitudinal research is necessary to clarify the causality.

The aim of this work was to compare in vivo measurements of direct current (dc) and alternating current (ac) obtained from acupuncture points in Ukrainian and Mexican residents. Measurements were made using the method of Voll. The participants were 43 healthy Ukrainian and 71 healthy Mexican residents aged between 20 and 30 years, as well as 24 Mexican patients with a clinical diagnosis of rheumatoid arthritis and 14 patients with a clinical diagnosis of allergy. The results showed that dc measurements are not directly applicable to different populations. Thus, the dc resistance of the acupuncture points in the Mexican participants was 4-5 times larger than in the Ukrainians. In contrast, the capacitance of the two groups did not differ by more than 25%. Impedance measurements from acupuncture points can be used as an efficient and prompt non-invasive method for diagnostic purposes.

Acupuncture is widely used by the American public, but little is known about its availability and use in academic medical settings. We performed a pilot study to compare acupuncture services provided by hospitals affiliated with a major academic teaching institution, and a parallel survey of services provided through an acupuncture school in one city in New England. Between December 2000 and July 2001, a telephone survey was conducted of the 13 hospitals affiliated with Harvard Medical School, and the clinics affiliated with the New England School of Acupuncture. Acupuncture was available in 8 of the 13 hospitals. Acupuncture was provided in ambulatory clinics in all eight hospitals, but was available to inpatients in only one hospital. Six hospitals delivered acupuncture through an outpatient pain treatment service, one through a women's health center, one through an HIV clinic, and one hospital delivered acupuncture through two services; a program in the anesthesia department and a multi-disciplinary holistic program in a primary care department. In contrast, the acupuncture school clinics provided services through an on-site clinic at the school, through acupuncture departments at two community-based hospitals, and through a network of 12 satellite acupuncture-dedicated clinics operating throughout the state. Acupuncture is available on a limited basis in a majority of the teaching hospitals in this city. At the acupuncture school clinics, there are few barriers to care. Future health care studies will need to examine the role of acupuncture in diverse geographic settings and to examine its impact on quality of care, teaching and its role in research in academic centers.

Stroke is a leading cause of morbidity and mortality and stroke survivors make up the largest group of patients in rehabilitation. These individuals also have one of the longest lengths of stay in rehabilitation. It has been suggested that acupuncture may be beneficial in post-stroke rehabilitation and in this study we examine how stroke patients value acupuncture and their perceptions of acupuncture as a rehabilitation treatment option. A questionnaire was distributed to individuals undergoing post-stroke rehabilitation at three rehabilitation centers attached to hospitals in Toronto, Canada. Two hundred and seventy-three individuals completed the questionnaire with the respondent group comprising mainly males (62%) over 65 years of age (68%). Overall 29% had used acupuncture with 16% receiving acupuncture treatment for stroke related conditions. Almost all respondents (98%) wanted to know more about acupuncture in stroke rehabilitation and 87% would consider acupuncture as a treatment option. Few (8%) reported that they had advanced level knowledge about acupuncture, with most reporting a basic (48%) or intermediate (33%) level which recognized that acupuncture used fine needles to produce a therapeutic response. Those with prior acupuncture experience expected to pay more for treatment. The main factors influencing decisions to use acupuncture were practitioner competency (84%), cost (65%) and sterilization concerns (40%). This study demonstrates that there is willingness by patients attending conventional hospital-based rehabilitation centers to consider acupuncture in stroke rehabilitation and that lack of knowledge about this treatment is not a barrier to use.

Case histories are necessary besides other types of evidence to convince doctors of a specific type action of homeopathic medicines. Prognosis of treatment does not merely depend on efficacy. Some considerations based on consensus meetings about best cases and prospective research into the relationship between symptoms and result. Many data in homeopathic literature are unreliable because of wrong interpretation, insufficient numbers and confirmation bias. Causal relationship between medicine and 'cure' could be documented better. Extraordinary cases are not helpful to increase reproducibility. For acceptance and improvement of homeopathy cases should be reproducible. 'Normal' cases reflecting daily practice contribute more to this goal than extraordinary cases. Accuracy can be increased by larger samples of comparable cases. Causal relationship between medicine and improvement should be further explored.

There is a need for large scale, pragmatic trials of complementary and alternative medicine in a primary care setting to answer questions about the 'real world' effectiveness of such methods. Randomisation and treatment in such trials should be prospective, but retrospective recruitment is possible, especially in chronic conditions. This involves contacting patients who have previously consulted their GP (identified through GP database searches) rather than encouraging GPs to refer patients as they present. We describe a prospective randomised trial of acupuncture for chronic headache, currently underway, as an example of retrospective recruitment. A pilot study of recruitment and recruitment modelling was undertaken. The target sample size was 300, 26% (n = 36) of general practices approached took part in the study, 32 completed the required database search. Practices used diagnostic term searches, prescription searches, or a combination of both. On average 1.7% of the total practice populations were identified as headache consulters, letters were sent to 4128 patients. 12% of identified patients were randomised (n = 401). Retrospective recruitment methods are feasible for CAM trials in chronic, stable conditions modelling can provide accurate data for planning such studies. Retrospective recruitment can be more efficient than prospective, further research is required on the generalisibility of results from populations recruited in this way.

Reflexology is an increasingly popular complementary therapy in which parts of the body are deemed to be represented on the soles of the feet. The aim of this study was to investigate whether this representation can be used as a valid method of diagnosis. Three experienced reflexologists took part in this study. Eighteen adults with one or more of six specified conditions were identified from primary care records. Two reflexologists, who were blinded to the patients' conditions and monitored, then examined each patient's feet and rated the probability that each of the six conditions was present. There is little evidence that the distribution of ratings vary with the status of the condition. Receiver operating curves suggest that this diagnostic method is very poor at distinguishing between the presence and absence of conditions. Inter-rater reliability (kappa) scores were very low, providing no evidence of agreement between the examiners. Despite certain limitations to the data provided by this study, the results do not suggest that reflexology techniques are a valid method of diagnosis.

Acne is one of the commonest diseases to afflict humanity. Anecdotally, the use of CAM in acne is widespread. In this review the empirical evidence for the efficacy of CAM modalities is examined and the context for their use discussed. Searches were made of the MEDLINE, EMBASE, AMED (Allied and Complementary Medicines), Cochrane, and DARE databases using the search terms "acne" and "acne vulgaris" together with "alternative" and "complementary". The identified studies examined a broad range of CAM modalities but were of generally poor methodological quality. Evidence suggests that many of these therapies are biologically plausible. Complementary therapies in acne should be viewed in a wider context than that of the very limited empiric evidence base that exists for their use. Further rigorously conducted trials should be conducted to define efficacy and adverse effect profiles of currently used CAM acne therapies.

To evaluate the effects of a low frequency acoustic waveform on peripheral vascular disease (PVD). Pilot study utilizing a one-group pre-intervention, post-intervention design. Adults with peripheral vascular disease were recruited through local advertisements. The study was conducted at a local facility housing the electroacoustic transducer. A 25-min exposure to an electroacoustic transducer. Pre- and post-measurement of Doppler ultrasound blood-flow velocities in 10 arteries, ankle brachial index (RBI), foot assessment, and 1-week post telephone survey. A significant increase was noted in the right ankle brachial index (RABI) but not the left. Blood flow increased in all arteries, significantly in four. Thirteen participants reported improvement in symptom of peripheral vascular disease over the following week. While conclusions must be viewed cautiously, the significant differences noted warrant further study to examine effects of acoustic waveforms on peripheral vascular disease.

Despite the expressed demand for complementary and alternative medicine (CAM) services in developed countries, little is known about the CAM workforce in terms of supply and composition. To describe the CAM workforce across five developed countries to better inform health workforce and health services planning, and perchance, inform debate on future public health and primary care policy. Data from the Australian, New Zealand, Canadian, UK and US Censuses of population were interrogated for information pertaining to the size and characteristics of the CAM workforce. This was supplemented by other population-level workforce data where available. The quality and availability of population-level data on the CAM workforce vary substantially across nations. Of the nine CAM disciplines explored, massage therapy consistently comprised the largest portion of the CAM workforce, followed closely by chiropractic. Disciplines in shortest supply were homoeopathy in Australia, traditional Chinese medicine in New Zealand, and naturopathy in the US. Across the broader CAM workforce, practitioners were typically female, aged ≥40 years, worked within a primary care setting, held a vocational or higher education level qualification, worked full-time, and earned <$1000 gross per week. This work has helped shape current understandings of the CAM workforce. In doing so, it will help to inform the training and continuing education needs of the evolving CAM workforce, and further, ensure the provision of a competent CAM workforce to service the needs of consumers. Addressing the many limitations of existing data sources will assist in meeting these needs.

Cupping worldwide has been part of traditional medicine systems and is in the western world used as CAM therapy mainly for treating pain syndromes. The mode of action is up to now unclear. In order to investigate its mechanism we measured in parallel metabolic changes in the tissue under the cupping glass and pressure pain thresholds. In 12 volunteers (6 healthy subjects and 6 patients with chronic neck pain) a microdialysis system was implanted subcutaneously on both sides (left and right) above the trapezius muscle. After baseline measures cupping was performed at one randomly selected side (left or right), the other side served as control. Every 20min during baseline measures and for 280min after cupping, microdialysis probes for detection of lactate, pyruvate, glucose and glycerin were taken. In addition, pain thresholds were measured before and after cupping with algometry. Cupping resulted in a strong increase of lactate (beginning 160min after cupping until the end of the measurements) and the lactate/pyruvate ratio, indicating an anaerobe metabolism in the surrounding tissue. Baseline pain thresholds were non-significantly lower in neck pain patients compared to healthy controls and slightly increased immediately after cupping (p<0.05 compared to baseline close to the area of cupping in healthy subjects and on the foot in neck pain patients). After 280min no more significant changes of pain thresholds were detected. Cupping induces >280min lasting anaerobe metabolism in the subcutaneous tissue and increases immediate pressure pain thresholds in some areas.

This investigation aims to test the effect of acupuncture on word generation activation (WGA) in post-stroke aphasia patients. Seven vascular aphasia patients and 14 control subjects were studied using functional magnetic resonance imaging (fMRI). Each performed: (1) a word generation (WG) task alone, followed by (2) repeating WG after insertion of acupuncture needles (WGN) into SJ 8 (a language-implicated acupoint), followed by (3) repeating WGN reinforced by electrical stimulation (WGA) of SJ 8, and finally (4) electrical stimulation (ES) of SJ 8 alone. Significant activation was found in the opercular, triangular, or insula during the ES stimulation in patients when comparing each patient to 14 normal controls. For the WG task, significant activation was found in the inferior frontal gyrus when comparing each patient to 14 normal controls. The signal induced by acupuncture was larger than that of the WG task in the left middle frontal gyrus with the comparison of WGA vs. WGN in seven patients. Further, main significant effects in the right insula in patients were observed when comparing seven patients to 14 normal controls. The activation induced by ES stimulation was only found on the left side in controls. This activation was observed on the lesion side of superior and middle frontal gyrus (SMFG) in patients. This study demonstrates for the first time that language-deficit-implicated acupoint stimulation can selectively activate the brain on the lesion side in post-stroke aphasia patients. These results suggest that acupuncture may have therapeutic benefits in post-stroke aphasia patients.

To investigate neural representation evoked by acupuncture from human somatosensory cortices, especially from primary (SI) and secondary (SII) somatosensory areas. Neuroimaging study - Blood-oxygenation-level-dependent (BOLD) functional MRI was performed during acupuncture on LI4 (n=12 healthy participants). Sham acupuncture and innocuous tactile stimulation were also applied on the same acupuncture site as control comparisons. Responsive neural substrates were visualized and identified based on both individual and group-level surface activation maps. Discrete regions within the precentral gyrus (area 4) and the fundus of the central sulcus (area 3a) were selectively activated during the real acupuncture stimulation. In SII, the activation was extended in a postero-inferior direction to the fundus of the lateral sulcus. This specific pattern of acupuncture-related activation indicates that deep tissue stimulation (as seen in area 3a activation) and concurrent processing of sensory stimulation (as seen in activation in SII) may mediate neural responses to manual acupuncture.