The prevalence of workaholism in Western populations is approximately 10%,although estimates vary considerably according to how “workaholism” is defined. There is growing consensus that workaholism is a bona fide behavioral addiction that exists at the extreme end of the work-engagement continuum and causes similar negative consequences to other behavioral addictions such as salience, conflict, tolerance,withdrawal symptoms,and mood modification. Other more specific consequences include
burnout, work compulsion,work–family conflict, impaired productivity, asociality, and psychological/somatic illness.
Recent decades have witnessed a marked increase in research
investigating the etiology, typology, symptoms, prevalence,and correlates of workaholism. However,despite increasing prevalence rates for workaholism, there is a paucity of workaholism treatment studies.Indeed, guidelines for the treatment of workaholism tend to be based on either theoretical proposals or anecdotal reports elicited during clinical practice.
Efforts to integrate complementary and alternative medicine (CAM) into conventional healthcare systems raise questions about expected levels of CAM use and its cost in an integrated system. This paper documents actual patient usage of a hospital-based alternative medicine clinic that has been operating on a conventional healthcare campus since 1993.
Hennepin Faculty Associates (HFA) is a multispecialty physician organization serving the Hennepin County Medical Center (HCMC), a public teaching hospital in downtown Minneapolis. In 1993, HFA opened an alternative medicine clinic, primarily providing acupuncture. The clinic has since expanded services to offer chiropractic, massage/bodywork, and herbs. Administrative claims data showing visit dates, treatment received, payment source, charges, and patient complaints are available from 1997 through 2002.
Of all HFA patients who received conventional care on the HCMC campus every year (1997-2002), 6.5% also received care at the Alternative Medicine Clinic (AMC). Nearly 80% of AMC patients received third-party reimbursement for AMC services. Averaged over 6 years, self-pay patients had 3.2 visits per year and incurred $173 in charges per year; patients with a mixture of third-party payment sources had 8.0 visits per year and incurred $634 in charges per year. Number of visits per patient per year remained relatively constant over the 6 years, except for patients aged 65 or older, who showed an increase in number of visits, particularly for acupuncture.
This report contributes a new perspective on use of CAM in the general population. Results from this perspective differ markedly from those provided by published survey data, showing a lower prevalence of use and lower charges incurred. Concern that insurance coverage for CAM would increase healthcare costs dramatically are not substantiated by these data.
To comprehend the results of a randomized controlled trial (RCT), readers must understand its design, conduct, analysis and interpretation. That goal can only be achieved through complete transparency from authors. Despite several decades of educational efforts, the reporting of RCTs needs improvement. Investigators and editors developed the original CONSORT (Consolidated Standards of Reporting Trials) statement to help authors improve reporting by using a checklist and flow diagram. The revised CONSORT statement presented in this paper incorporates new evidence and addresses some criticisms of the original statement.
The checklist items pertain to the content of the Title, Abstract, Introduction, Methods, Results and Discussion. The revised checklist includes 22-items selected because empirical evidence indicates that not reporting the information is associated with biasedestimates of treatment effect or the information is essential to judge the reliability or relevance of the findings. We intended the flow diagram to depict the passage of participants through an RCT. The revised flow diagram depicts information from four stages of a trial (enrolment, intervention allocation, follow-up, and analysis). The diagram explicitly includes the number of participants, for each intervention group, included in the primary data analysis. Inclusion of these numbers allows the reader to judge whether the authors have performed an intention-to-treat analysis.
In sum, the CONSORT statement is intended to improve the reporting of an RCT, enabling readers to understand a trial's conduct and to assess the validity of its results.
Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs.
We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr Sierpina at vssierpiutmb.edu or Dr Kreitzer at kreit003umn.edu. Submissions should be no more than 500 to 1,500 words. Please include any Web site or other resource that is relevant, as well as contact information.
biloba’s peripheral and central effects are thought to be mediated by a variety of mechanisms, including antioxidant and antiplatelet-activating factor properties, cerebrovascular modulating properties (ie, enhancing blood flow), neurotransmitter potentiating activity, and effects on glucose metabolism. 3 Although rare, adverse side effects have included skin reactions, headache, and mild gastrointestinal upset. 3 Ginkgo has shown some efficacy in improving neurologic and cognitive functions in patients with Alzheimer disease, multiinfarct dementia, aging, idiopathic cognitive impairment, 4,5 and in the symptomatic treatment of impairments in memory, concentration, and depression. 3,5 Although individuals taking EGb 761 have shown some improvement in mood and fatigue, few investigators have assessed its efficacy in ameliorating cognitive impairments in MS. 4 In a recent study authors reported that the use of Ginkgo may positively impact susceptibility to interference and mental flexibility 6 and some evidence points to improvements on the Paced Auditory Serial Addition Test and a Perceived Deficits scale of a Quality of Life Index compared to placebo-treated patients (240 mg/day for 90 days). 7,8 In this pilot study we examined the effects of EGb 761 on cognitive performance in MS. The data are derived from a previous study 4 in which we performed a randomized, placebocontrolled, double-blinded, parallel group design in accordance with appropriate institutional review and the ethical standards set forth in the Helsinki Declaration of 1975. The final analyses were performed with 12 participants in the Ginkgo intent-totreat group and nine participants in the placebo group. The goal was to determine the effect of ginkgo versus placebo on information processing and executive function and evaluate the relative contributions of fatigue and mood in mediating changes in
Acute bronchitis is a widespread medical problem, and, although predominantly caused by viruses, antibiotics are still prescribed unnecessarily. Therefore, it is of utmost importance to evaluate the use of alternative treatments for acute bronchitis.
To evaluate the efficacy and safety of a Pelargonium sidoides preparation (EPs 7630 is a registered trademark of Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany) compared with placebo in patients with acute bronchitis.
Randomized, double-blind, placebo-controlled trial using a design with planned interim analyses.
Six outpatient clinics.
One hundred twenty-four adults with acute bronchitis present </=48 hours, Bronchitis Severity Score (BSS) >/=five points, and informed consent.
EPs 7630 or placebo (30 drops three times daily) for seven days.
The primary outcome criterion was the change of BSS on day seven.
The decrease of BSS from baseline to day seven was 7.2 +/- 3.1 points with EPs 7630 (n = 64) and 4.9 +/- 2.7 points with placebo (n = 60). The 95% confidence interval for the difference of effects between the two treatment groups (EPs 7630 minus placebo) was calculated as (1.21, 3.56) showing a significant improvement of EPs 7630 compared with placebo on day seven (P < .0001). For each of the five individual symptoms, rates of complete recovery were considerably higher in the EPs 7630 group. Within the first four days, onset of treatment effect was recognized in 68.8% of patients in the EPs 7630 group compared with 33.3% of patients in the placebo group (P < .0001). Health-related quality of life improved more in patients treated with EPs 7630 compared with placebo-treated patients. Adverse events occurred in 25 of 124 patients (EPs 7630: 15/64 patients, placebo: 10/60 patients). All adverse events were assessed as nonserious.
EPs 7630 was superior in efficacy compared with placebo in the treatment of adults with acute bronchitis. It may therefore offer an effective alternative for acute bronchitis unless antibiotics are clearly indicated.
The use of equine therapy for abused women requires hard work and the confluence of significant resources. First, there must be a therapist with the knowledge and skill necessary to use the gifts horses offer us and who is comfortable and experienced working through the aftermath of abuse. It also requires well-trained and socialized horses able to stay connected in the company of clients as they process their abuse and find their voice in a natural environment conducive to the work. Finally, it takes clients willing to pursue nontraditional options for treatment. Facing ones past abuse and its lingering effects is always a difficult journey. Having the courage to take that journey in the company of horses is particularly challenging for women without voice. When it all comes together, the results are synergistic and profound and the relationships gained are often long maintained. It is not uncommon for the women who have done this work to desire continued connection with the horses that took the journey with them. The congruence in the ongoing relationship seems to keep them centered. More than once, I have heard their voices ring out loud and clear across the pasture calling Waggoner, Ready, or Mystic, and the hoofbeats of a nearing horse in response.
This review examines the educational accreditation standards of four licensed complementary and alternative medicine (CAM) disciplines (naturopathic medicine, chiropractic health care, acupuncture and oriental medicine, and massage therapy), and identifies public health and other competencies found in those standards that contribute to cooperation and collaboration among the health care professions. These competencies may form a foundation for interprofessional education. The agencies that accredit the educational programs for each of these disciplines are individually recognized by the United States Department (Secretary) of Education. Patients and the public are served when healthcare practitioners collaborate and cooperate. This is facilitated when those practitioners possess competencies that provide them the knowledge and skills to work with practitioners from other fields and disciplines. Educational accreditation standards provide a framework for the delivery of these competencies. Requiring these competencies through accreditation standards ensures that practitioners are trained to optimally function in integrative clinical care settings.
Interest in CAM and mind-body therapies (MBT) among mental health professionals has increased over the last decade. Individuals seeking treatment for mental health concerns often use MBTs and expect clinicians to be aware of such treatments. Yet, current data reveal a critical gap in training, practice, and the needs of those seeking treatment.
To determine the attitudes, beliefs, and practices of marriage and family therapists regarding MBTs.
Electronic survey method using Likert-type scale questions.
Clinical faculty members and graduate students (N = 140) from accredited Marriage and Family Therapy programs in the United States and Canada.
Findings revealed that a majority of respondents believed that graduate programs should introduce MBT topics during course of training and that MBTs are valuable in the treatment of various clinical problems. Respondents were familiar with at least one form of MBT and reported using such in personal and professional settings.
Children frequently suffer infections accompanied by fever, which is commonly treated with acetaminophen (paracetamol), a use not devoid of risk.
The effect of a complex homeopathic medicine (Viburcol, Heel Belgium, Gent, Belgium) was compared with that of acetaminophen in children with infectious fever.
Non-randomized observational study.
Thirty-eight Belgian centers practicing homeopathy and conventional medicine.
Children <12 years old.
Viburcol (drops) or acetaminophen (pills, capsules, or liquid form) for a maximum of 2 weeks.
Fever, cramps, distress, disturbed sleep, crying, and difficulties with eating or drinking. Symptoms were graded by the practitioner on a scale from 0 to 3. Severity of infection was evaluated on a scale from 0 to 4. Data were captured on body temperature, subjective impression of health status, time to first improvement of symptoms, and global evaluation of treatment effects. Tolerability and compliance were monitored.
Both treatment groups improved during the treatment period. Body temperature was reduced by 1.7 degrees C +/- 0.7 degrees C with Viburcol and by 1.9 degrees C +/- 0.9 degrees C with acetaminophen; fever score (scale from 0 to 3) from 1.7 +/- 0.6 to 0.1 +/- 0.2 with Viburcol and from 1.9 +/- 0.7 to 0.2 +/- 0.5 with acetaminophen (all values mean +/-SD). The overall severity of infection (scale from 0 to 4) decreased from 2.0 +/- 0.5 to 0.0 +/- 0.2 with Viburcol and from 2.2 +/- 0.7 to 0.2 +/- 0.6 with acetaminophen. There were no statistically significant differences between treatment groups in time to symptomatic improvement. Viburcol was noninferior to acetaminophen on all variables evaluated. Both treatments were very well tolerated, but the Viburcol group had a significantly greater number of patients with the highest tolerability score.
In this patient population, Viburcol was an effective alternative to acetaminophen treatment and significantly better tolerated.
The SchwartzReport tracks emerging trends that will affect the world, particularly the United States. For EXPLORE it focuses on matters of health in the broadest sense of that term, including medical issues, changes in the biosphere, technology, and policy considerations, all of which will shape our culture and our lives.
A growing body of literature has been accumulated over the past 30 years to explore the effect of acustimulations (AS) including acupuncture, acupressure, and electrical stimulation of acupoints on symptoms of nausea and vomiting (NVS) across various patient populations.1-10 Medical and nursing professionals around the world (United States, Canada, Japan, Korea, Taiwan, India, Pakistan, United Kingdom, Ireland, Sweden, Germany, Norway, Austria, Italy, Greece, Croatia, Australia, Israel, and others) have participated in generating clinical trials to identify the best evidence-based practices. The authors have organized this body of literature into a series of metaanalyses to yield meaningful summative evidence and conclusions about the effects of AS on NVS. This brief overview paper provides a description of the current evidence and the need to perform a series of metaanalyses of AS on NVS across three patient populations: postoperative adults, pregnant women, and postoperative children. A metaanalysis of the effect of AS on NVS postoperative adults is reported in this issue of EXPLORE, and two subsequent papers in future issues will provide details of individual metaanalysis for pregnant women and postoperative children.
A clinical trial reported in JAMA (Shay et al, 1998), involving acupuncture and amitriptyline in HIV-infected patients, concluded that there was no effect for either acupuncture or amitriptyline on neuropathic pain. However, a recent reassessment of this study showed that there were really three different and independent clinical trials, each with a different research design, which had been combined into a single database and consequently analyzed with a relatively insensitive statistics. When only the first substudy, factorially crossed design involving acupuncture and amitriptyline, was reanalyzed by itself using more powerful statistics, it was found that acupuncture and amitriptyline both worked independently to reduce pain, but also that acupuncture worked best in the absence of amitriptyline, and that there may have been adverse events associated with the combination of the two treatments. The present study reports the reanalysis of the second of the original independent studies involving only acupuncture and sham acupuncture, to determine whether the results confirm acupuncture-related findings from the first substudy.
Subjects were 114 HIV-infected men with pain associated with peripheral neuropathy in the early 1990s, when antiretroviral drug cocktails were just beginning to be available in experimental form.
The second of the independent studies in the original report by Shlay et al involved a single factor with two levels: a 14-week standardized acupuncture regimen and its control (off-point sham acupuncture). In addition, physical functioning at baseline (high or low, based on the Karnofsky scale), was factorially crossed with the acupuncture factor in our analyses. Primary data were reanalyzed using repeated-measures ANCOVA in an intention-to-treat procedure, and categorical data were analyzed by the Pearson chi-square test.
Pain intensity, pain relief, mortality, and attrition.
Whereas the results were inconclusive for the pain measures, acupuncture had a strong and positive effect on attrition and mortality. These results were most pronounced among patients with poorest physical functioning at the beginning of the study. Overall, acupuncture was associated with lower attrition rate (27.6% vs. 44.6%, P = .058), and a zero mortality rate (0% vs. 12.5%, P = .047). This protective effect of acupuncture was visible primarily in subjects in poorer health (0% vs. 23.8%, P = .047).
Acupuncture was clearly effective in reducing attrition and mortality in this sample, especially when health status was taken into account, but results for pain relief were mixed. These results add further evidence that the use of the most sensitive statistics available increases the chance of detecting actual effects due to acupuncture (and other treatments as well). Moreover, these results replicated most of the findings that did not involve the presence of amitriptyline from the initial independent study in this research project. The combined results of these two studies strongly support the importance of recognizing that interactions involving acupuncture and other treatments, may positively as well as negatively modify main effect results in clinical trials, and thus must be recognized and systematically explored. Findings are discussed in terms of their implications for moving toward a whole-systems approach to biomedical research.
Nadine E. Foster, DPhil, is Professor of Primary Care Musculoskeletal Rehabilitation, Arthritis Research UK National Primary Care Centre, Primary Care Sciences, at Keele University, Staffordshire, England.
Background: There is interest from the community in the use of self-help and complementary therapies for depression. This review examined the currently available evidence supporting the use of acupuncture to treat depression. Objectives: To examine the effectiveness and adverse effects of acupuncture in the treatment for depression. Search Strategy: The following databases were searched: CCDAN-CTR, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to Dec 2008), EMBASE (1980 to Dec 2008), PSYCINFO (1874 to Dec 2008), the Database of Abstracts of Reviews of Effectiveness (DARE), CINAHL (1980 to Dec 2008), Wan Fang database (to Dec 2008). The following terms were used: depression, depressive disorder, dysthymic disorder and acupuncture. Selection Criteria: Inclusion criteria included all published and unpublished randomized controlled trials comparing acupuncture with sham acupuncture, no treatment, pharmacological treatment, other structured psychotherapies (cognitive behavioral therapy, psychotherapy or counseling), or standard care. The following modes of treatment were included: acupuncture, electro acupuncture, or laser acupuncture. The participants included adult men and women with depression defined by clinical state description, or diagnosed by the Diagnostic and Statistical Manual (DSM-IV), Research Diagnostic Criteria (RDC), International Classification of Disease (ICD) or the Criteria for Classification and Diagnosis of Mental Diseases CCMD-3-R. Data Collection and Analysis: Meta-analyses were performed using relative risk for dichotomous outcomes and standard mean differences for continuous outcomes, with 95% confidence intervals. Primary outcomes were reduction in the severity of depression, measured by self-rating scales, or by clinician rated scales and an improvement in depression defined as remission versus no remission. Main Results: This review is an update and now contains data from 30 studies. Following recent searches, 23 new studies have been added and a further 11 trials were excluded (due to suboptimal doses of medication, no clinical outcomes, insufficient reporting). Thirty trials with 2,812 participants are included in the meta-analysis. There was a high risk of bias in the majority of trials. There was insufficient evidence of a consistent beneficial effect from acupuncture compared with a wait list control or sham acupuncture control. Two trials found acupuncture may have an additive benefit when combined with medication compared with medication alone. A subgroup of participants with depression as a comorbidity experienced a reduction in depression with manual acupuncture compared with SSRIs (RR 1.66, 95%CI 1.03, 2.68) (three trials, 94 participants). The majority of trials compared manual and electro acupuncture with medication and found no effect between groups. Authors' Conclusions: We found insufficient evidence to recommend the use of acupuncture for people with depression. The results are limited by the high risk of bias in the majority of trials meeting inclusion criteria.
Recent research has elucidated several different mechanisms for acupuncture. However, the interrelationship between these mechanisms and how acupuncture affects complex physiological systems is still not understood. Heart rate Variability (HRV), the beat-to-beat fluctuations in the rhythm of the heart, results from the regulation of the heart by the autonomic nervous system (ANS). Low HRV is associated with increased risk of all-cause mortality and is a marker for a wide range of diseases. Coherent HRV patterns are associated with increased synchronization between the two branches of the ANS, and when sustained for long periods of time result in increased synchronization and entrainment between multiple body systems. There is strong evidence from randomized placebo controlled trials that acupuncture modulates HRV. This may represent a mechanistic pathway for global physiological regulation, which is congruent with East Asian medical theory. The ability of acupuncture to improve HRV could be used as a tool in acupuncture research and practice to monitor treatment effectiveness and the impact on quality of life.
Assessment of the radial pulse by palpation (pulse diagnosis) is an important diagnostic technique in Traditional Chinese Medicine (TCM), but the changes of blood flow volume in the radial artery during and after acupuncture are unknown.
The aim of this study was to explore the changes of radial artery blood flow volume during and after acupuncture in healthy subjects.
This study was conducted as a pilot study utilizing a one-group intervention design.
The study was conducted at a TCM outpatient clinic of Tohoku University Hospital.
Twenty-six healthy volunteers participated in the study.
Acupuncture was performed at LR-3 bilaterally with manual rotation of the needles.
Blood pressure was measured at rest and 180 seconds after acupuncture. Radial artery hemodynamics were monitored continuously with a high-resolution ultrasound echo-tracking system. The vessel diameter and blood flow volume of the right radial artery and heart rate were measured at rest, before acupuncture, during acupuncture, and 30, 60, and 180 seconds after acupuncture.
The systolic and diastolic diameter of the radial artery did not significantly change. Radial artery blood flow volume decreased significantly during acupuncture (mean +/- SD, 0.16 +/- 0.11 mL/sec per m(2); P < .01) compared with baseline (0.43 +/- 0.27 mL/sec per m(2)), but was increased at 180 seconds after acupuncture (0.54 +/- 0.28 mL/sec per m(2); P < .01).
The present study showed that radial artery blood flow volume decreased immediately during acupuncture at the LR-3 acupoint, but was increased at 180 seconds after acupuncture.
Background: Acupuncture has recently been studied in assisted reproductive treatment (ART), although its role in reproductive medicine is still debated. Objectives: To determine the effectiveness of acupuncture in the outcomes of ART. Search Strategy: All reports that describe randomized controlled trials of acupuncture in assisted conception were obtained through searches of the Menstrual Disorders and Subfertility Group Specialised Register, CENTRAL, Ovid MEDLINE (1996 to August 2007), EMBASE (1980 to August 2007), CINAHL (Cumulative Index to Nursing & Allied Health Literature) (1982 to August 2007), AMED, National Research Register, Clinical Trials register (www.clinicaltrials.gov), and the Chinese database of clinical trials. Selection Criteria: Randomized controlled trials of acupuncture for couples who were undergoing ART comparing acupuncture treatment alone or acupuncture with concurrent ART versus no treatment, placebo, or sham acupuncture plus ART for the treatment of primary and secondary infertility. Women with medical illness deemed contraindications for ART or acupuncture were excluded. Data Collection and Analysis: Sixteen randomized controlled trials were identified that involved acupuncture and assisted conception. Thirteen trials were included in the review and three were excluded. Quality assessment and data extraction were performed independently by two review authors. Meta-analysis was performed using odds ratio (OR) for dichotomous outcomes. The outcome measures were live birth rate, clinical ongoing pregnancy rate, miscarriage rate, and any reported side effects of treatment. Main Results: There is evidence of benefit when acupuncture is performed on the day of embryo transfer (ET) on the live birth rate (OR 1.89, 95% confidence interval [CI] 1.29-2.77) but not when it is performed two to three days after ET (OR 1.79, 95% CI 0.93-3.44). There is no evidence of benefit on pregnancy outcomes when acupuncture is performed around the time of oocyte retrieval. Authors' Conclusions: Acupuncture performed on the day of ET shows a beneficial effect on the live birth rate; however, with the present evidence this could be attributed to placebo effect and the small number of women included in the trials. Acupuncture should not be offered during the luteal phase in routine clinical practice until further evidence is available from sufficiently powered RCTs.
Research of the effects of one acupuncture method for patients with glaucoma, focusing on intraocular pressure (IOP) and visual acuity.
To explore the possibility of using acupuncture for patients with glaucoma.
Pilot study utilizing a one-group preintervention, postintervention design.
Eleven patients with glaucoma were recruited through advertisement at the clinic for glaucoma.
Acupuncture was carried out twice a week over 5 weeks.
IOP, visual acuity, and subjective symptoms were observed at 15 minutes before and after acupuncture once a week and in a four-week follow-up.
IOP was significantly improved at 15 minutes after acupuncture, at one week, two weeks, and five weeks and tended to be lower weekly. Uncorrected visual acuity was significantly improved at three weeks, four weeks, and five weeks, and best corrected visual acuity was significantly improved at five weeks. However at the four-week follow-up, significance remained only in uncorrected visual acuity.
Although these results should be interpreted cautiously, acupuncture can be used to supplement the conventional therapy for glaucoma.
Although acupuncture and homeopathy both have a theoretical background that refers to immaterial forces difficult to verify, they are nevertheless used and accepted as effective treatments by many individuals.
We intended to investigate whether and how users of acupuncture and homeopathy differ with respect to sociodemographic data, adaptive coping strategies, and attitudes toward complementary and alternative medicine (CAM).
In an anonymous questionnaire survey among 5,830 elderly German health insurants, we identified individuals who used CAM within the last five years.
Acupuncture was used by 10% of the population, homeopathy by 7%, and both by 5%. More men than women used acupuncture, whereas homeopathy was used equally by women and men. Acupuncture users had a reduced physical health status compared to homeopathy users. In most cases, it was not a disappointment with conventional medicine that accounted for CAM usage. Stepwise regression analyses revealed that the best predictors of acupuncture and homeopathy usage were the conviction that CAM is more profound and expends more time, fear of the side effects of conventional medicine, and high scores in the measure of search for information and alternative help. Negative predictors were physical health, male gender, age, and trust in a scientific rationale of treatments.
We found that usage of distinct CAM approaches might depend on particular psychosocial profiles, attitudes, and convictions. In contrast to homeopathy users, acupuncture users seemed to be much more pragmatic and referred more often to an expected scientific background of chosen treatment. Our findings fill a gap of knowledge that needs further attention.