Article

Indirect and non-health risks associated with complementary and alternative medicine use: An integrative review

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Abstract

Introduction Complementary and Alternative Medicine (CAM) is being increasingly used across the general population, with much attention drawn to the direct health risks associated with rising CAM use–particularly in respect to efficacy and drug-herb interaction. However the potential for other forms of risk associated with increased CAM use has received far less attention. This review article provides the first broad overview and appraisal of potential non-health and indirect health risks associated with CAM use. Methods A comprehensive search of literature from 2000 to 2011 in CINAHL, MEDLINE, AMED, and EMBASE was conducted. The search was confined to peer-reviewed articles published in English reporting non-health and indirect health risks associated with CAM. Results The review identifies a number of non-health risks associated with CAM use. These can be broadly categorised as risks due to variability; risks due to assumption; risks due to opportunity costs; economic risks, and risks due to unorthodoxy. Indirect and non-health risks may also compound or exacerbate existing direct risks associated with CAM treatment. Conclusion In order to fully appreciate and appraise the relative merits of CAM practice and provision, researchers need to be mindful that a range of potential risks (beyond direct health risks) may be associated with CAM use. Adequate regulatory and policy frameworks need to be put in place to ensure that these risks are minimised.

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... Direct risk is any adverse effects from using any herb, food item, supplement, or health-related practice [34]. Indirect risk is not directly related to a specific medicine or herb but harms the patient due to the treatment setting or practice in general [35], such as untrained health professionals, poor communication between healthcare professionals and patients, lack of authentic information, etc [33,35]. According to a systematic review of adverse drug reactions (ADR) in Norway [36], 250 out of 260 ADR reports of plant-based products submitted to RELIS (Manufacturer-independent drug information for healthcare professionals) were related to herbal dietary supplements [37]. ...
... Direct risk is any adverse effects from using any herb, food item, supplement, or health-related practice [34]. Indirect risk is not directly related to a specific medicine or herb but harms the patient due to the treatment setting or practice in general [35], such as untrained health professionals, poor communication between healthcare professionals and patients, lack of authentic information, etc [33,35]. According to a systematic review of adverse drug reactions (ADR) in Norway [36], 250 out of 260 ADR reports of plant-based products submitted to RELIS (Manufacturer-independent drug information for healthcare professionals) were related to herbal dietary supplements [37]. ...
... Getting information about TM from the internet (social media and Google) using non-scientific sources was revealed. It aligns with another study [35] showing information variability as a common indirect risk. Usually, such information has misleading claims about effect and safety. ...
Article
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Background Pakistani immigrants are the largest non-Western ethnic minority group in Norway. Traditional medicines (TM) are extensively used in Pakistan, and studies show that ethnic minorities also use them to recover from illness after migration to the Western world. This study aims to explore Pakistani immigrants’ experiences and perceptions of risk regarding the use of TM to treat illnesses. Methods A qualitative study was conducted through in-depth interviews (n = 24) with Pakistani immigrants in Norway from February to March 2023. Participants were recruited through purposive and snowball sampling methods. The data was analyzed using Braun & Clarke’s reflexive thematic analysis (RTA) using Nvivo. Results RTA revealed three main themes and six sub-themes. The main themes were: (a) House of knowledge, (b) Choosing the best possible approach for health restoration, and (c) Adverse effects of TM used. A total of 96 different TM were identified, including herbs, food items, animal products, minerals, herbal products, and ritual remedies. All participants used TM to restore health in acute and chronic diseases, and many used TM along with conventional medicines. The participants’ mothers were the primary source of knowledge about TM, and they passed it on to the next generation. They also frequently used religious knowledge to recover from illness. Although TM is considered safe because of its natural origin, some participants experienced adverse effects of TM, but none of them reported it to the health authorities. Conclusion The study helps to understand the experiences and perceptions of risk of Pakistani immigrants in Norway regarding traditional practices for treating health complaints. Public health policies to improve the health of these immigrants should consider the importance of TM in their lives. Further research is necessary to explore the safety and toxicity of those TM that are common in Pakistani households in Norway.
... While potentially offering some benefit in terms of more patient-centred or socially and culturally accessible care, the pluralistic health seeking pattern among EVD survivors in this study may present potential direct and indirect risks that undermine EVD survivors' safety and health outcomes. Direct risks include inherent risks from the medicine (conventional or T&CM), and it can include adverse effects due to herbal-drug interaction or adulteration or contaminated T&CM product (Wardle & Adams 2014). Indirect risks may result from poor and delayed diagnosis of a health problem or delay in receiving the required treatment. ...
... T&CM safety should also be viewed beyond its inherent risk ( T&CM-drug interaction or T&CM contamination) but also indirect risks associated with incorrect safety information sourced from non-professionals (Wardle & Adams 2014). Going forward, clinical research is needed to produce evidence of clinical interactions between conventional therapies and commonly used TCAM modalities. ...
... Direct risks are also not the only area of potential concern. Even in cases where EVD survivors may be aware of the direct risks associated directly with T&CM use (such as drug interactions or other adverse events), they may not consider potential indirect risks such as delayed healthcare seeking behaviour, incorrect diagnosis and treatment, often as the result of poor regulation of T&CM products and practices (Wardle & Adams 2014). As such, it recommended that EVD survivors need to be aware of safety concerns and direct and indirect risks associated with T&CM, and the need to be informed that such risks can occur even in products often perceived as safe and natural. ...
Thesis
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𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Evidence suggests that Ebola virus disease (EVD) survivors are suffering from immediate and long term physical and mental health complications, some of which are severe. While current research has focused on understanding the sequelae of EVD survivors in the post-Ebola era, healthcare-seeking behaviour of EVD survivors is largely unknown. This PhD study aimed to investigate EVD survivor’s healthcare-seeking behaviour with particular emphasis on their use of traditional and complementary medicine (T&CM) products and services in Sierra Leone. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀: This thesis employed an exploratory partially mixed, concurrent dominant status triangulation research design. Male and female adult EVD survivors with post-Ebola sequelae were recruited for both the quantitative and qualitative arms of the study. The quantitative survey explored EVD survivors’ (n=358) pattern of healthcare utilisation, attitude towards T&CM and Ebola-related stigma. The qualitative arm employed a descriptive exploratory, inductive approach using focus group discussion sessions (n=4) to collect data on EVD survivors’ (n=41) healthcare-seeking experiences and preferences. Descriptive statistics and backward stepwise binary regression analysis were used to analyse quantitative data while the framework approach was used to guide qualitative data analysis. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: The quantitative survey indicated EVD survivors visited a healthcare provider (n = 308, 86.0%), self-medicated with conventional medicines (n =255, 71.2%) and visited a private pharmacy outlet (n = 141, 39.4%). EVD survivors also self-medicated with T&CM products (n = 107, 29.9%), concurrently self-medicated with conventional and T&CM products (n = 62, 17.3%), and visited a T&CM practitioner (n = 41, 11.5%). Almost half of EVD survivors (n = 163, 45.5%) reported using T&CM treatments for post-Ebola related symptoms and non-Ebola related symptoms since their discharge from an Ebola treatment centre. EVD survivors who perceived that T&CM boosted their immune system, that T&CM had fewer side effects than conventional medicine, or that T&CM provided them with more control than conventional medicine over their health were more likely to use T&CM compared to who do not hold those views. Also, EVD survivors were more influenced to use T&CM based on their personal experience of the effectiveness of T&CM than by clinical evidence. EVD survivors reported higher levels of internalised stigma (0.92 ± 0.77) compared to enacted stigma (0.71 ± 0.61). EVD survivors who experienced enacted stigma were [AOR=4.58, 95%CI: 1.51-13.83, p=0.007] more likely to use T&CM. Verbal abuse [AOR = 1.95, 95%CI: 1.09–3.49, p = 0.025] and healthcare neglect [AOR = 2.35, 95%CI: 1.37–4.02, p = 0.002] were independent predictors of T&CM use among EVD survivors. The qualitative component revealed that conventional healthcare was the first choice of treatment option for most EVD survivors immediately following their discharge from the Ebola treatment centre (ETC). However, EVD survivors described the current Free Healthcare Initiative (FHCI) as inadequate in addressing their healthcare needs. Personal and health system factors influenced EVD survivors’ decision to seek non-formal healthcare approaches, especially T&CM. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: The findings from this thesis provide the first ever insights into how EVD survivors navigate the healthcare landscape to address their health needs. The findings of this thesis are useful for policymakers, healthcare providers and EVD survivors, and it highlights the need for further research to explore this topic more closely.
... The use of T&CM among Ebola survivors may present direct and indirect risks that could undermine their health outcomes and quality of life [23,24]. Direct risk includes inherent adverse effect, toxicity or adverse effects due to conventional-T&CM drug interactions and heavy metal contamination [23]. ...
... Direct risk includes inherent adverse effect, toxicity or adverse effects due to conventional-T&CM drug interactions and heavy metal contamination [23]. Indirect risk includes lack of education and training of T&CM practitioners as well as poor T&CM regulation [23][24][25]. The risk that T&CM posed to Ebola survivor's safety may be exacerbated, given that the majority of patients in Sierra Leone do not disclose their use of T&CM to healthcare providers (HCPs). ...
... For healthcare professionals, this association to science and technology is essential and may influence their perception of, and recommendation for the use of T&CM. The direct (adverse effect, toxicity and heavy metal contamination), indirect (models of disease causality and treatment, lack of standardised education and training and poor regulation) risks to survivors' safety that T&CM is known to possess may further explain HCPs' negative perception of T&CM in our study [23,24]. ...
Article
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Background Considerable number of patients, including Ebola survivors, in Sierra Leone, are using traditional and complementary medicine (T&CM). Healthcare providers’ (HCPs) views about T&CM is crucial in addressing the increased need for T&CM among patients. However, healthcare providers’ views about T&CM in Sierra Leone is unknown. Our study explores healthcare providers’ knowledge of and perception towards T&CM and how that influence their personal and professional T&CM use, communication with Ebola survivors about T&CM as well as its integration into the healthcare system in Sierra Leone. Methods We employed a qualitative exploratory study design using semi-structured interviews to collect data from 15 conveniently sampled HCPs in all four geographical regions of Sierra Leone. We analysed our data using thematic network analysis framework. Results Healthcare providers perceived their knowledge about T&CM to be low and considered T&CM to be less effective and less safe than conventional medicine as well as not evidence-based. HCPs perception of T&CM as non-scientific and their lack of knowledge of T&CM were the key barriers to HCPs’ self-use and recommendation as well as their lack of detailed discussion about T&CM with Ebola survivors. HCPs are open to T&CM integration into mainstream healthcare in Sierra Leone although at their terms. However, they believe that T&CM integration could be enhanced by effective professional regulation of T&CM practice, and by improving T&CM evidenced-based knowledge through education, training and research. Conclusion Changing HCPs’ negative perception of and increasing their knowledge about T&CM is critical to promoting effective communication with Ebola survivors regarding T&CM and its integration into the healthcare system in Sierra Leone. Strategies such as educational interventions for HCPs, conducting rigorous T&CM research, proper education and training of T&CM practitioners and effective professional regulation of T&CM practice could help in that direction.
... Traditional knowledge about medicinal plants, and the biocultural heritage derived from them throughout history, can be a useful tool for curriculum design in health sciences. Moreover, they represent a pathway closely related to self-care, self-medication, and even pharmaceutical preparation in magistral formulas as an alternative to medicines and their collection in the field, which is not without risk [1][2][3]. In this sense, research on this topic oriented toward the teaching and learning processes of secondary school or university students has an interesting potential from a multidisciplinary or interdisciplinary and transdisciplinary approach [4][5][6][7][8]. ...
... It should be discussed whether the use is very local or widespread, whether the species is still used a lot, little, or not at all, whether it is traded informally, whether only certain uses have been lost, whether there are historical references to indicate how long we know the practices have been in use, its efficacy, and possible health risks. Finally, comment on possible health risks [1][2][3]. ...
Article
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Traditional knowledge about medicinal plants, and the biocultural heritage derived from them, can be a useful tool for curricular design in health sciences. Research on this topic oriented toward university students has an interesting potential from a multidisciplinary or transdisciplinary treatment. This field allows for establishing relationships between socioeconomic and environmental problems and the health and well-being of people from the perspective of the intangible heritage of rural communities. On the other hand, traditional knowledge draws from very diverse sources such as empirical, magical, and religious components, primitive medicines, and even from academic medicine itself when it ceases to be scientific. Methodological triangulation is used in terms of data (times, spaces, and people), as well as researchers from different areas of knowledge integrating approaches with an interpretive purpose. Located in a European transboundary territory, the study area contains the mountain ranges of Alor (Spain) and São Mamede (Portugal), two cross-border areas where key informants have been interviewed. The observation unit is people who perform traditional practices to gather natural products, and other randomly selected informants. The study was completed with information collected from the undergraduates of the Escola Superior de Saúde de Portalegre (Portugal). The purpose of this work was to highlight the application of traditional knowledge based on medicinal plants in university studies of health sciences. Based on the results obtained and an epistemological discussion, we propose an educational intervention to broaden the professional mindset from a biocultural perspective. Our proposal directs the student’s gaze toward the investigation of medical history and biocultural heritage to understand the determinants of health and to respect the idiosyncrasies of their communities.
... hypervitaminosis is another risk [16]. Moreover, cases of illegally added PD to Ds have been disclosed, also for products marketed as cognitive enhancement supplements [17]. in addition, Ds may impose indirect risks, that is risk related to the condition of use, for patients with dementia [11,18], such as mixing Ds up with PD or taking more Ds than recommended [11]. ...
... Qualitative methods may contribute to a better understanding and improved level of knowledge regarding important health and well-being issues. an interview guide (see supplementary Material 1) was developed by the authors and the patient research partners (see acknowledgements) based on the aim of the study and previous research [11,18,24,25]. the interview was piloted by asking the questions from the interview guide to one GP not participating in the study. the goal was to explore whether the questions were relevant to general practice, and to evaluate the time-use. ...
Article
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Objective: The use of dietary supplements (DS) may cause harm through direct and indirect effects. Patients with dementia may be particularly vulnerable. This study aims to explore general practitioners' (GPs') experiences with DS use by these patients, the GPs perceived responsibilities, obstacles in taking on this responsibility, their attitudes toward DS, and suggestions for improvements to safeguard the use of DS in this patient group. Design: Qualitative individual interview study conducted February - December 2019. Data were analysed using systematic text condensation. Setting: Primary healthcare clinics in Norway. Subjects: Fourteen Norwegian GPs. Findings: None of the informants were dismissive of patients using DS. They were aware of the possible direct risks and had observed them in patients. Most GPs showed little awareness of potential indirect risks to patients with dementia who use DS. They acknowledged the need for caretaking of these patients. Although there were differences in practice styles, most of the GPs wished to help their patients safeguarding DS use but found it difficult due to the lack of quality assurance of product information. Furthermore, there were no effective ways for the GPs to document DS use in the patients' records. Several suggestions for improvement were given by the GPs, such as increased attention from GPs, inclusion of DS in the prescription software, and stricter regulatory systems for DS from the authorities. Conclusion: The GPs had initially little awareness of this safety risk, but there were differences in practice style and attitudes towards DS. The GPs did not perceive themselves as main responsible for safe use of DS in patient with dementia. The most important reason to disclaim responsibility was lack of information about the products. One suggestion for improvement was better integration of DS in patients' medical record.
... 12,13 The presence of a mental health condition is a known threat to implementing and maintaining recommended healthy behaviours, such as diet, exercise, limiting alcohol consumption, and following routine care protocols, 9,14,15 in turn creating different diabetes management risk profiles for women and men. Additionally, reported risks 16 and benefits 17 of complementary medicine, associated with women's propensity to use these treatments, 18,19 further differentiates women's diabetes management risk profiles from those of men. ...
... Direct risks typically refer to health-related harms and indirect risks are not health-related harms (eg financial losses). 16 One known driver of potential harms is non-disclosure of complementary medicine use to primary care practitioners, 18,25 thereby removing opportunities for communication between patient and practitioner, and thus clinical governance. In addition, complementary medicine is often selfprescribed 26,27 and used concurrently with conventional medicine, 28 raising the potential for adverse health outcomes. ...
Article
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Management of diabetes mellitus continues to pose challenges for primary health-care professionals, with estimates of as many as 2 million Australians requiring ongoing care. Although most cases are men, women living with diabetes have presenting concerns and self-management characteristics distinct from men. A threat to women’s optimal diabetes management is being at greater risk of developing mental health conditions, especially for women with insulin-dependent type 2 diabetes. In addition, complementary medicine use is highly prevalent among women and is associated with significant direct and indirect risks, which raises clinical governance issues. To date, limited gender-specific diabetes research exists that has explored women’s diabetes self-management behaviours and risk profiles. We argue that this is essential to inform the design of targeted care approaches that address clinical governance issues and help health-care professionals to better support women living with diabetes.
... 4 CM plays a substantial but often hidden role in primary and secondary healthcare in Australia 5,6 and poses similar direct (eg, malpractice) and indirect (eg, failure to appropriately refer through misdiagnosis or monopolisation of care) risks to patients in common with other forms of health service. 7 However, CM also presents specific challenges for patients, healthcare professionals and those managing the healthcare system. For example, CM often involves promotion and distribution through online sources, use which goes undetected, and products or practices that may not always conform to standards expected of regulated health services and products. ...
... experience of registration of Chinese medicine found that simply incorporating this profession into a well-known regulatory mechanism (state-based registration) resulted in a five-fold increase in complaints, as complaints that had otherwise been lost were able to be appropriately reported. 7 Such confusion may be confounded by the hesitance of the government to incorporate CM professions and practices into regulatory schemes, even when multiple public government inquiries have made this recommendation. Over a period of more than twenty years, multiple inquiries by three State governments and the Federal government have recommended the government regulation of naturopaths, yet to date there has been no regulatory action. ...
Article
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Background: Complementary medicine (CM) use is a ubiquitous aspect of an increasingly consumer-driven model of healthcare delivery and plays an increasingly prominent role in the Australian health sector. Yet there is limited empirical research investigating the quality and integrity of protections for consumers in Australia. The aim of this study is to help address this gap in knowledge by exploring how members of the public engage with protection mechanisms related to CM use. Methods: This study utilised a cross-sectional online survey to recruit a sample of 1132 Australian adults aged 18 and over. Purposive convenience sampling was used to recruit participants from an existing database of Australian adults who had expressed interest in participating in research. Results: The majority of the participants (64.0%) had visited a CM practitioner in their lifetime. However, a minority of participants (36.9%) indicated they would feel confident in knowing where to complain if something went wrong with the treatment they received from a CM practitioner. Most participants (74.7%) had used a CM product in their lifetime. Specifically, 32.3% had 'ever' used an herbal product and 69.9% had 'ever' used a nutritional supplement. However, a minority of participants (32.7%) indicated they would feel confident knowing where to complain if something went wrong with a herbal or nutritional supplement they used. Most participants indicated a lack of knowledge about how CM practitioners and CM products are regulated in Australia. Conclusion: The findings of this study clearly highlight a concerning lack of knowledge by CM patients and consumers regarding the regulation of CM in Australia. From a policy perspective, it is necessary to seek proactive approaches that target complaint-related knowledge of the CM patients and consumers through education and advocacy efforts.
... This includes taking vitamins and minerals, herbal products, homeopathic medicines, and other natural health products in an effort to maintain and improve health and quality of life (Public Health Agency of Canada 2008). With the common use of these products in Canada, there is the possibility of a number of issues that may adversely affect health, including CAM/nutrient/drug interactions, direct clinical risks of adverse events (including hepatoxicity of CAM products) and inefficacy of these treatments leading to the delay or outright refusal of evidence-based conventional treatments (Johnson et al. 2018;Wardle and Adams 2014). Given that the provision of CAM and medical nutrition therapy are not considered controlled acts under Ontario' s Regulated Health Professions Act (RHPA 1991), "nutritionists" in Ontario are permitted to recommend vitamins and minerals, herbal products, homeopathic "medicines" and other natural health products regardless of their knowledge and training in this area. ...
... Reports of higher rates of health and nutrition concerns being addressed and increased likelihood of following through with recommendations provided by RDs suggest that RDs should be the primary provider of nutrition information and advice in Ontario. Furthermore, the highly reported incidences of "nutritionists" recommending supplements (with no accountability to a regulatory body) is cause for concern due to possible CAM-nutrient interactions, direct clinical risks, adverse events and inefficacy of these treatments, leading to delayed or refusal of evidence-based conventional treatments (Johnson et al. 2018;Wardle and Adams 2014). ...
Article
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Background: Current Ontario healthcare policy permits anyone to use the title "nutritionist" and practice as a clinician regardless of education and training. The title "dietitian," on the other hand, is protected under the Dietetics Act (1991) for use exclusively by individuals who undergo rigorous education and training in evidence-based nutrition. Objectives: The objectives of this study were to: identify whether the Ontario general public understands the difference between a registered dietitian (RD) and an unregulated "nutritionist;" understand experiences with RDs and "nutritionists;" and determine if the current nutrition landscape arising from gaps in healthcare policy has the potential to harm the public. Methods: A cross-sectional mixed methods survey study was carried out using inductive content analysis, descriptive statistics and chi-square tests. Results: Respondents (n = 402) did not understand the difference between RDs and "nutritionists." Overall, public experiences have been significantly more positive when nutrition information/advice stemmed from an RD. Implications: This study provides justification for proposed legislative amendments to the Dietetics Act (1991) and the Regulated Health Professions Act (1991). These proposed amendments have been detailed in the full-text manuscript.
... Nevertheless, the most frequently reported source of information for HM use during pregnancy in this study were family, friends, and neighbors (98.3%), and only 7.5% of respondents obtained the information from health professionals such as doctors, herbalists, midwives, and health workers. Although the credibility of information provided by non-healthcare professionals cannot be guaranteed [35], such dependency on informal sources of information was also seen in other studies [3,21]. Consistent with previous studies, these findings reflect the need for healthcare professionals to have an adequate understanding of HM use during pregnancy to ensure the safety of mother and child and prevent potential misuse. ...
... As such, despite the high utilization and lack of adequate source of information on HM, only 54.8% of respondents have disclosed HM use to healthcare professionals during pregnancy. Although the disclosure rate among Nepali women was higher compared to other studies [4,21,36,37], almost half of the respondents failed to communicate with their physicians on HM use, and several studies revealed the negative consequences of poor communication between patients and healthcare professionals on HM use [35,38]. Furthermore, consistent with previous findings, commonly reported reasons for non-disclosure included doctors not asking about HM use, and pregnant women's belief that it is not important to disclose HM use [10,39]. ...
Article
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Background Pregnant women’s disclosure of herbal medicine (HM) use to their health care providers during pregnancy is crucial, as misuse of HM can have a detrimental effect on both pregnant woman and the fetus. However, the lack of disclosure of HM use to physicians remains a public health concern in developing countries such as Nepal. Methods A cross-sectional study was conducted among 400 postpartum women admitted at Maternity and Women’s Hospital located in Kathmandu, Nepal. The survey instrument included 30 questions on the use of HM during pregnancy, sociodemographic and health characteristics, and pregnancy outcomes. Chi-square test and logistic regression were conducted for data analysis using SPSS ver. 21.0., and a p-value of less than 0.05 was considered statistically significant for all analyses. Results 60.3% of respondents used at least one herbal remedy during their previous pregnancy, and the overall disclosure rate of HM use to healthcare providers was 54.6%. Women with secondary education level and four or more antenatal care visits were more likely to disclose their HM use to healthcare providers. Conclusions This study highlights that despite the popular use of HM among pregnant women in Nepal, most women obtained HM-related information from informal sources and did not disclose their HM use to physicians. To ensure the safe use of HM, physicians should integrate questions regarding patients’ HM use into their routine patient assessments to facilitate active communication and improve the quality of care.
... Substantial use of TCM among those with arthritis is reason enough to insist this topic be a core focus for public health and health services research, yet there are other circumstances that further spotlight the significance of investigating TCM use for arthritis, ideally via a multi-disciplinary perspective and approach. The majority of TCM use among those with arthritis occurs concurrently to conventional medical treatment (2)-a situation that introduces potential direct and indirect risks (11). There are direct risks related with TCM use for arthritis-regarding adverse events (e.g., itching, skin rashes, redness) from TCM patches, as well as TCM-conventional drug reactions (e.g., lassitude, nocturia, cold extremities) and indirect risks associated with the quality of TCM herbs and formulations owing to geographical or seasonal variations, as well as potential information about practitioner variability in TCM knowledge and communication between patients and practitioners (11). ...
... The majority of TCM use among those with arthritis occurs concurrently to conventional medical treatment (2)-a situation that introduces potential direct and indirect risks (11). There are direct risks related with TCM use for arthritis-regarding adverse events (e.g., itching, skin rashes, redness) from TCM patches, as well as TCM-conventional drug reactions (e.g., lassitude, nocturia, cold extremities) and indirect risks associated with the quality of TCM herbs and formulations owing to geographical or seasonal variations, as well as potential information about practitioner variability in TCM knowledge and communication between patients and practitioners (11). ...
Article
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A substantial number of arthritis sufferers utilise traditional Chinese medicine (TCM) as part of their treatment plan worldwide. Unfortunately, clinical evidence for TCM in arthritis remains limited and such use raises a number of significant potential challenges to the wider coordination of safe, effective care for arthritis patients. Moreover, patients in the treatment of arthritis are at higher risk of infectious diseases (e.g. influenza, and the recent coronavirus disease 2019) due to comorbidities and immunosuppressive therapy. Given these circumstances, it is important that a critical, rigorous public health and health services research agenda around TCM use for arthritis be undertaken to help inform all stakeholders, especially those providing conventional care and treatments, and ensure the best possible coordinated care for patients with arthritis.
... 19 This is especially problematic for ingested products that could interact with conventional medications to either reduce or increase drug activity. 20 It is also important to understand the extent of women's use of informal healthcare for chronic illness and how this intersects with conventional care; for example, do women more commonly utilise one treatment type or choose to use multiple practices and products in parallel? This is a significant research gap. ...
... 25,30 Lack of communication with health practitioners is particularly concerning as people who engage in evidence-based self-care have better health outcomes. 25 Given the potential direct and in-direct risks associated with the concurrent use of formal and informal healthcare 20 ...
Article
Objective: This study aims to describe the prevalence of health care utilization (including conventional medicine, self-care and complementary medicine treatments) for the management of asthma by women aged 45 years and over and their associated out-of-pocket expenditure. Methods: A self-reported mail survey of 375 Australian women, a cohort of the national 45 and Up Study, reporting a clinical diagnosis of asthma. The women were asked about their use of health care resources including conventional medicine, complementary medicine, and self-prescribed treatments for asthma and their associated out-of-pocket spending. Spearman’s correlation coefficient, student’s t-test and chi-square test were used as appropriate. Population level costs were created by extrapolating the costs reported by participants by available national prevalence data. Results: Survey respondents (N = 375; response rate, 46.9%) were, on average, 67.0 years old (min 53, max 91). The majority (69.1%; n = 259) consulted at least one health care practitioner in the previous 12 months for their asthma. Most of the participants (n = 247; 65.9%) reported using at least one prescription medication for asthma in the previous 12 months. The total out-of-pocket expenditure on asthma treatment for Australian women aged 50 years and over is estimated to be AU$159 million per annum. Conclusions: The breadth of conventional and complementary medicine health care services reported in this study, as well as the range of treatments that patients self-prescribe, highlights the challenges of coordinating care for individuals living with asthma.
... Certain CAM practices are considered an inappropriate option for healthcare, since they challenge some basic assumptions of orthodox medicine (Mizrachi, Shuval, and Gross 2005). CAM is often surrounded by controversy and scrutiny, caused to a large extent by the inappropriate safeguards to minimise the potential harm for CAM users (Wardle and Adams 2014). Wardle and Adams (2014, p. 412) state that "failure to regulate a CAM profession can lead to a steady decline in training standards, particularly when combined with professional fragmentation or lack of a defined standard for CAM practitioners." ...
... Depending on the predominant logic in their background, they may feel uncomfortable running a for-profit establishment or making decisions whether to treat a patient who cannot afford a treatment. Such clashes of logics would reflect on their notion of success (Wardle and Adams 2014). Fourth, CAM hybridity extends beyond the health/business boundaries as CAM combines practices and techniques from the West such as medicine and the East such as healing (Keshet, 2010). ...
Article
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The organisational literature privileges objective performance indicators often selected by researchers. There is scarce research on legitimacy challenged hybrid and micro-organisations and on perceived success under exigent conditions. To fill in this gap, the study, conducted among complementary and alternative medicine (CAM) micro-organisations, explores success as a subjective measure originating from managers' perceptions. For the purpose, it integrates Cognitive Mapping and Multiple Criteria Decision Analysis (MCDA)-a methodological contribution to construct a subjective success framework that can be helpful for contested hybrid micro-organisations. Seven factors emerged, of which human capital is recognised as critical while external factors are considered unimportant.
... CM by definition (i.e. complementary) is generally not utilised within conventional medicine [2] and the use of these treatments has the potential for direct and indirect risks [3]. For example, concomitant use of herbal medicines with pharmaceutical drugs carries the risk of herb-drug interactions if not appropriately managed [4]. ...
... Similarly, the decision to retain two items despite their non-significant outer weights and loadings was theoretically based. The first of these items measured a belief about the safety of CM, which is one of the primary concerns underpinning the need for improved disclosure Note: R 2 = 1 in formative second-order constructs as it is fully explained by its indicators. of CM use to physicians [3,4]. The second item measured whether or not their doctor asked about their CM use, which has been found to be an important influencer of CM use disclosure [5,20]. ...
Article
Objective: Non-disclosure of complementary medicine (CM) use to doctors is associated with health risks. No standardised, validated instrument exists to measure reasons for CM use disclosure behaviour to doctors in clinical research or practice. This study aims to develop and validate an index that measures the relative importance of reasons for CM disclosure and non-disclosure. Methods: Using data from the Complementary Alternative Medicine Use Health Literacy Disclosure Study (N = 2019), we developed a CM Disclosure Index (CMDI) using a formative measurement approach. The adequacy of the measurement models was assessed by conducting variance-based structural equation modelling using partial least squares to analyse multicollinearity, significance and relevance of the formative indicators to their relative primary constructs. Results: The CMDI consists of two second-order measurement models, each with three sub-domains, and demonstrated acceptable construct validity indicating the index is a useful measure to identify the reasons for CM use disclosure behaviour. Conclusion: The CMDI provides a preliminary tool to measure the relative importance of the reasons for CM use disclosure and non-disclosure to doctors. Practice implications: Understanding patients' reasons for disclosure and non-disclosure can assist in developing targeted interventions to both patients and practitioners to facilitate effective patient-practitioner communication and improve patient safety.
... It is also argued that a large amount of the CM products being consumed may be of little or no health benefit to consumers or pose health risks (Wardle and Adams, 2014). For example, CM products are primarily self-prescribed by consumers, and studies have found that these medicines are not necessarily taken for their evidence-based indications (McIntyre et al., 2015). ...
... Self-care is a critical component of health care that has benefits for individuals and health care systems. However, effective decision-making related to self-care relies on adequate health literacy and access to reliable information about TM and CM (Wardle and Adams, 2014). ...
... Several factors may contribute to this attitude, including the perception that CAM is irrelevant, a lack of concern, or the assumption that the physician would disapprove or not believe them. While serious adverse effects from CAM are relatively rare, significant direct and indirect risks still exist [72], particularly with ingestible biologicallybased therapies like herbal products or dietary supplements [73]. These products can be sourced unreliably, self-prescribed, or used without professional supervision [74,75]. ...
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Background Despite the paucity of scientific evidence, complementary and alternative medicine (CAM) is widely used for the prevention and treatment of chronic illness, holistic care, and counteracting the adverse effects of conventional therapies. This study aims to determine the prevalence of CAM use and its associated factors among patients undergoing hemodialysis (HD) in Taiwan. Methods This quantitative study was conducted from August 2022 to July 2024 in the HD unit at Kaohsiung Chang Gung Memorial Hospital in Taiwan. Face-to-face questionnaire-based interviews were held with 154 of 163 eligible patients (response rate, 94.5%) at the bedside during HD. The completed questionnaires were entered into a secure computer database. Data was performed by descriptive analysis, Chi-square, and Fisher tests. Results More than half of the patients were CAM users (n = 86; 56%), and women was associated with significantly more usage of CAM. Fifty-six CAM users took Chinese herbal medicine (CHM), 52.3% (n = 45) used dietary supplements, and 19.8% (n = 17) used acupuncture. The benefit in the effectiveness of CAM was the main reason for use, the need of CAM to improve the well-being and HD-related complication was high. 32.7% of patients had used CAM based on recommendation from their family and friends. More than one-third (33.7%) of patients did not disclose their use of CAM to their doctors, most of them think it is unnecessary. Conclusions The use of CAM by patients with maintenance HD was relatively frequent. Of these, most used CHM, of which are shown to the trend into routine HD care is inevitable by high coverage and utilization in Taiwanese national health insurance system. These findings indicate that it is important for health care providers working in dialysis to assess CAM use.
... Studies indicate that a considerable percentage of cancer patients, ranging from 20% to 77%, depending on the study setting, do not disclose their usage of CIH to their treating physicians [74][75][76]. This lack of communication can potentially undermine the doctor-patient relationship and, in the long run, exacerbate the risk of delayed diagnosis or discontinuation of conventional therapy [77,78]. Additionally, interactions between herbal remedies or dietary supplements and chemotherapeutic agents are potential risks that can be identified and addressed by the specially trained personnel during these counselings. ...
Article
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Complementary and integrative healthcare (CIH) is increasingly recognized as a valuable approach to empowering and activating cancer patients. Studies have shown that higher patient activation is positively associated with improved health outcomes and reduced healthcare costs. The CCC-Integrativ study aimed to assess the implementation of an evidence-based counseling service on CIH at four Comprehensive Cancer Centers (CCC) in Germany. In this controlled implementation study, the patient-level intervention included three CIH consultations within a 3-month period delivered by interprofessional teams of physicians and nurses. The primary endpoint was patient activation using the PAM-13 at baseline (T1) and post-intervention (T2), and compared between control (CO, receiving routine care) and the intervention group (IG) using an analysis of covariance. Missing data were handled with multiple imputations. Maintenance effects at 6-month follow-up (T3) were investigated using a linear mixed model. A total of n = 1128 oncology patients (CO = 443, IG = 685) with diverse tumor entities and cancer stages were included in the study. The overall mean baseline PAM-13 score was 69.74 (SD = 14.24) (n = 959 (85.0%)). A statistically significant between-group difference in post-intervention PAM-13 scores was observed (Fgroup(1, 1866.82) = 8.634, P = 0.003), with an adjusted mean difference of 2.22 PAM-points. Age, gender, tumor entity, disease stage, or CCC study site did not significantly predict post-treatment PAM-13 scores. The maintenance effect of the intervention was not statistically significant (FtimeXgroup(1, 3316.04) = 2.337, P = 0.096). Individually tailored counseling on CIH, offered by specifically trained, interprofessional teams, significantly improved patient activation. Given the established positive effects of higher patient activation, the implementation of such a program at cancer centers may yield beneficial outcomes for both patients and the healthcare system.
... In recent years, Complementary and Alternative Medicine (CAM) has become steadily more recognized and accepted by ordinary people and people with chronic illnesses around the world [7][8] . CAM is de ned by the National Center for Complementary and Alternative Medicine (NCCAM) as a group of medical and health care systems that are different from traditional medicine [9] . ...
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Objective To investigate the characteristics of patients with inflammatory arthritis (IA) who use complementary and alternative medicine (CAM) and to examine the relationship between pain, fatigue, anxiety, depression, and sleep status in patients with IA and the use of CAM. Method A cross-sectional study was conducted at the Department of Rheumatology and Immunology, First Affiliated Hospital of Anhui Medical University in Anhui, China between October 2021 and February 2022. Unpaired Student's t-tests, Chi-square tests, and Pearson correlation tests were employed to compare users versus non-users. Finally, logistic regression analysis was used to explore the independent influences on the use of CAM in inflammatory joint disease. Result Significant associations were found between Multidimensional Fatigue Inventory (MFI) scores, the Depression-Anxiety-Stress Self-Assessment Scale (DASS-21), and the Pittsburgh Sleep Quality Index (PSQI), and CAM use. The results showed that the logistic regression model was statistically significant (χ2 = 64.891, P = 0.000), and the model diagnostic compliance rate was 65.2%. The Hosmer Leeshawn test showed P = 0.787 > 0.05 and the model was well fitted. Conclusion Overall, older age, longer disease duration, higher disease activity, and more severe anxiety levels were associated with higher rates of CAM utilization.
... There are barriers and risks associated with CM use in health care settings [27]. One example is the risk associated with concurrent use of CM and psychopharmacological treatments [28] -some herbal medicines used for mental health problems, such as Hypericum perforatum (St John's wort), can potentiate the effects of selective serotonin reuptake inhibitors creating greater risk of serotonin syndrome [20,23,28]. ...
Article
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Amidst the global rise in complementary medicine (CM) use for mental health, a substantial number of clients consulting a psychologist also utilise at least one form of CM. Yet, how psychologists should engage with CM in their clinical practice (e.g., how to respond to a client disclosing CM use or enquiries regarding CM products or services for mental health) remains contested and unclear. In response, a systematic integrative review was conducted to examine empirical literature reporting on one or more aspects of the relationship between psychology (incorporating clinical practice, professional associations and academia) and CM, and how that relationship may relate to or inform psychologists' engagement with CM in their clinical practice. Twenty-seven peer-reviewed articles met the specific inclusion criteria and quality appraisal was employed. Analysis shows a substantial number of psychologists are engaging with, or are interested in engaging with, CM in their clinical practice. Analysis identified a dissonance between psychologists’ engagement with CM in clinical practice and the limited engagement of the broader discipline of psychology with CM. Further research is required to understand these differing types of engagement with a view to helping inform relevant policy and practice guidelines, and ultimately assist psychologists in navigating CM in their clinical practice.
... However, improper usage and habits pose risks such us CAM-related adverse effects or delayed diagnosis/treatment [14]. Especially in modern society, where information is rapidly and widely disseminated, CAM users may be exposed to biased or misleading information [15][16][17][18]. ...
Article
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Background Terminally ill patients often experience exacerbations of diseases that render mainstream medicine ineffective in relieving symptoms, prompting attempts at complementary and alternative medicine (CAM). This study collected data from terminally ill patients and their relatives to determine differences between CAM use, behavioral patterns, and perceptions of health information about CAM. Methods A cross-sectional design using a self-administered questionnaire was adopted. Eight medical institutions in Taiwan with inpatient hospice palliative care units were chosen. Ninety-two terminally ill patients and 267 relatives met the inclusion criteria. The questions concerned the experience of CAM use, the kinds of products/services CAM provided, the purpose of CAM use, the source of CAM information, and the perceptions and attitudes toward CAM. Results Both terminally ill patients and their relatives have a high proportion of lifetime and one-year prevalence of CAM use (88.0% vs. 88.4%; p = 0.929). CAM use for musculoskeletal and neurological discomfort is higher among terminally ill patients than among their relatives. Relatives/friends are the most frequent sources of information on CAM (53.3% vs. 62.2%; p = 0.133). The percentage of terminally ill patients who discontinued mainstream medical treatment because of CAM use was higher than that of their relatives (18.5% vs. 9.3%; p = 0.026). More than half the terminally ill patients and their relatives had never been asked about CAM by medical staff (64.1% vs. 66.7%), nor had they informed medical professionals about the use of CAM products and services (63% vs. 66.9%). Random inquiries by medical professionals may be associated with increased disclosure of CAM use (terminally ill patients: odds ratio, 9.75; 95% confidence interval, 1.97–48.35 vs. relatives: odds ratio, 5.61; 95% confidence interval, 2.66–11.83). Conclusions The high prevalence and concealment of CAM use in terminally ill patients should be considered. Medical professionals should establish a friendly and barrier-free communication model, encourage patients to share CAM experiences, and provide evidence-based information on the use of CAM products and services, to reduce the potential damage caused by harmful use.
... Complementary and alternative medicines (CAMs) are increasingly popular (Cant & Sharma, 2004;Coulter & Willis, 2004;Coulter & Willis, 2007;World Health Organization, 2019), despite the scarcity of clinical evidence for the efficacy and safety of many of these therapies (AMA, 2012). This is important as there are direct and indirect health risks associated with CAM (Wardle & Adams, 2014), such as herbal interactions with conventional medicines, and harm that occurs because patients may delay or stop using proven conventional medicine in favour of a CAM that has no evidence of efficacy (Braun et al., 2014). ...
Thesis
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There are many people who choose alternative or unorthodox healthcare options that are not based on the best available evidence for efficacy and effectiveness. There has been a rejection of vaccination by sections of the population leading to suboptimal rates of vaccination, and increased rates of infectious diseases such as measles. Complementary and alternative medicines (CAMs) are also increasingly popular, despite the scarcity of clinical evidence for the efficacy and safety of many of these therapies. The goal of this thesis is to explore unorthodox worldviews that predict vaccine scepticism and use of CAM in order to inform the future development of persuasive strategies to encourage participation in evidence-based interventions. Four studies were undertaken to achieve this goal including (1) the development of a standardised measure of CAM utilisation using data from an archived population survey of Australian adults; (2) an investigation of explanatory factors, including personality (openness to experience), cognitive style, and a range of unorthodox beliefs, for the relationship between CAM use and vaccination scepticism, using an archived population survey of Australian adults; (3) an examination of associations between geographic or area-level socio-demographic factors and uptake of vaccination among 5-year old children throughout Australia, using a public health focused ecological methodology, and (4) conducting an online priming experiment, to assess whether increasing the salience of concepts of contamination and purity will produce changes in reactions to a range of health interventions, including vaccination and CAM. Following are the key findings. The first study developed a brief, summative questionnaire measure of CAM utilisation called the R-I-CAM-Q, to address a gap in previous research which was lacking a psychometrically sound, and quantitative measure of CAM utilisation. The main findings of the second study, a cross-sectional survey, were that Pro-CAM attitudes, rather than CAM-use, best predict vaccination attitudes; and that anti-vaccination and pro-CAM attitudes both correlate with the presumed antecedents of magical beliefs about health. The geographic/area-based study revealed that communities with lower rates of vaccination had relatively less disadvantage, and had relatively greater education and occupational status, suggesting that privilege puts people at risk. The priming experiment showed no experimental effect of priming for contamination or purity/naturalness. Nevertheless, higher levels of sensitivity to disgust were associated with lower ratings of the effectiveness of MMR vaccination, tetanus injection, antibiotics, and surgery. The results of these studies into how unorthodox or alternative worldviews predict vaccination scepticism and use of CAM, can directly inform the future development of evidence-based health promotion strategies which encourage the uptake of best practice healthcare, including vaccination practices.
... Amongst the participants not seeking medical care, 8% used over-the-counter medicines and 16% used CMs to self-treat [12]. In the case of SDs, there are direct and indirect risks associated with the use of CMs, including inappropriate treatment choices, potential drug interactions with other CMs and conventional pharmaceutical treatments [13], and potential adverse treatment outcomes [14,15]. Research evaluating potential interactions between herbal medicines and drugs suggested that Kava (Piper methysticum) and Valerian (Valeriana officinalis), commonly used by people with SDs, should not be used with benzodiazepine receptor agonists [16,17]. ...
Article
Objective To explore the difference in rates and reasons for disclosure of either conventional or complementary medicine (CM) to healthcare practitioners between people living with sleep disorders (SDs) and those without SDs. Methods A cross-sectional survey (N = 2019 adults) that measured sociodemographic characteristics, health status, health service utilisation, health literacy and health communication (medicine disclosure) of a representative sample of Australians was conducted. Data from participants reporting an SD (n = 265) were compared to those not reporting an SD to assess measures of health communication and disclosure about medicine use. Results Overall, rates of medicine disclosure to both conventional and CM practitioners were high, in respondents with (70%) and without an SD (57%). Those reporting an SD had higher expectations of their conventional health practitioner’s knowledge of CM, associated clinical decision-making skills, and approval of CM use, and held a higher degree of concern about drug interactions (P < 0.05). The main reasons cited for disclosing CM use to conventional health practitioners and conventional medicine use to CM practitioners were “I want them to fully understand my health status” and “I was concerned about drug interactions with the CMs used.” Conclusion The high rate of medicine use disclosure by people with SDs is driven by an intention to inform their healthcare practitioner about their health status and concerns about potential medicine interactions. Therefore, research about the expectations that people with an SD have of their conventional healthcare practitioners’ knowledge of CM and CM-drug interactions requires further examination. Likewise, further examination of CM practitioner’s conventional medicine knowledge is encouraged.
... Direct risks come from the T&CM intervention itself (e.g., poor manufacturing quality, contamination) or its interactions with other therapies (e.g., herb/drug interactions). Examples of indirect risks include opportunity costs when a less effective TC&M is used in place of other effective treatments, delays in seeking medical care and failure to deliver prescribed therapies or T&CM medicines being taken in sub-therapeutic doses [30]. According to the recent study, the use of T&CM medicines has increased significantly among individuals who are afraid of contracting COVID-19, without considering the potential harmful effects of such drugs [10]. ...
Article
Objective Coronavirus disease 2019 (COVID-19) caused a universal psychosocial impact and individuals exposed to threats prefer to try self-care interventions and adhere to non-conventional approaches such as traditional and complementary medicine (T&CM) for preventive purposes. This study was conducted to determine the use and belief about T&CM among the general population during the COVID-19 outbreak. Method A cross-sectional online survey was carried out among the general population (aged ≥ 18 years) of Adana, Turkey during the strict lockdown period (April 11 to April 30, 2020). The survey instrument included details about sociodemographic characteristics, general information, T&CM use and beliefs was distributed among eligible participants via social media channels (Instagram, WhatsApp and Facebook accounts). Results Out of the total 389 participants, almost 39.3% (n=153) of the participants were the T&CM user and 60.7% were non-T&CM user during COVID-19 in this study. Additionally, 61 (39.8%) participants reported the usage of more than one form of T&CM modalities. Most of them used herbal medicine (30.8%), followed by nutritional supplements/vitamins (23.8%). Around 33.9% (n=52 out of 153 T&CM user) of participants did not report T&CM use to their family physicians. A statistically significant difference was observed between T&CM users and non-T&CM users in gender, age, marital status, level of education, income, and prior use of T&CM (p<0.05). Social media (n=204; 52.4%) was the primary source of information for T&CM use. Overall, 33.7%, 54.8% and 39% of the participants believed that T&CM therapies are effective, have fever side-effects/safe and should be use for COVID-19 respectively. Consclusion During the outbreak of COVID-19, a significant proportion of the population reported the use of T&CM. Different beliefs about T&CM were also observed. Better-structured T&CM-specific educational programs, enhanced physician-patient communication and access to reliable information by authentic sources are needed for the appropriate T&CM use during pandemics in Turkey.
... Supporting this argument is the uncertainty regarding T&CM practitioner competence and training standards which was frequently reported by stakeholders in this review, including T&CM practitioners. These, together with other nonhealth risks of T&CM practices, have been extensively reviewed by researchers with many of these risks purported to be exacerbated by lack of regulation [123]. These findings suggest that risks to consumers posed by T&CM practices may be mitigated by appropriate regulatory mechanisms that promote greater public protections via appropriate standards and accountability, while ensuring that consumer choice is protected, and practices can be appropriately integrated where there is evidence of patient benefit. ...
Article
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Background There has been a considerable increase in the number of traditional and complementary medicine (T&CM) practitioners over the past 20 years and in some jurisdictions are estimated to outnumber general practitioners. Despite this globally significant role, it is apparent that worldwide not all T&CM professions operate under adequate accountability and regulatory oversight for maintaining public protection. To date there has been no published systematic examination of stakeholder opinions regarding regulated and unregulated T&CM occupations. In response, this review aims to investigate, describe, and analyse attitudes held by a range of stakeholder groups towards the regulation of T&CM professions. Methods A database search of AMED, CINAHL, Embase, Ovid MEDLINE, ProQuest, PsycINFO, PubMed, Scopus, and Google Scholar was conducted for original research published between 2000 and 2020 on stakeholder opinions regarding the regulation of T&CM professions. Results Sixty studies across 15 countries reported on the views of six health care stakeholder groups: consumers, T&CM practitioners, conventional medicine practitioners, professional associations, education providers, and policy-makers. Across all stakeholder groups there was between 15% and 95% (median 61%) support for, and 1% to 57% (median 14%) opposition to the regulation of various T&CM professions. The main reasons for supporting regulation included providing greater public protection, raising training and practice standards, establishing title protection, and gaining acceptance from conventional medicine providers. Concerns regarding regulation included potential restrictions to practice, misappropriation of practice, and medical oversight of T&CM practitioners. Few studies canvassed the views of professional associations ( n = 6), education providers ( n = 2), and policy-makers ( n = 2). Conclusions There appears to be broad support for the regulation of T&CM professions, although there was wide variation in attitudes as to how this should be applied. Further research, with a particular focus on policy-makers, education providers, and professional associations, is critical to inform appropriate health policy and practice recommendations relating to T&CM professional regulation across jurisdictions. Systematic review registration: the a priori protocol for this systematic review was registered in PROSPERO and is available at: www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42020198767 .
... [6][7][8] Nondisclosure of T&CM use is prevalent, [9][10][11][12] and a recognised risk. 13 Such risks are further compounded by a lack of communication between HCPs and are potentially avoidable. 2 Effective IPC between all the HCPs that a patient chooses to consult, is key to coordinating safe and effective multidisciplinary care. ...
Article
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Background: The Australasian Integrative Medicine Association (AIMA) established a working group to develop the AIMA Guiding Principles for Letter Writing and Letter Writing Templates. The guiding principles were developed to promote effective communication between the diverse range of healthcare practitioners (HCPs) that patients choose to consult. Following the development of the Interprofessional Communication (IPC) resources, AIMA undertook a public consultation as part of a quality assurance process to evaluate the relevance and utility of the resource. Aim: This study reports stakeholder feedback on AIMA's draft guiding principles document. It explores stakeholder attitudes towards IPC and HCPs letter-writing, and interest in ongoing continuing professional development (CPD). Methods: A cross-sectional survey involving 1) an online public consultation survey and 2) a paper survey collected following IPC CPD activities. Quantitative data were analysed using Chi square and Fisher-Freeman-Halton Test. Responses to open ended questions were coded and subject to a thematic analysis. Results: The 64 survey participants and 55 CPD participants represented the Australian healthcare sectors and lay community. Most thought IPC is important (n = 112/117; 96%) and the resources were informative (n = 112/119; 94%), understandable (n = 111/119; 93%), and clinically relevant (n = 105/117; 90%). HCP reported wide variations in their frequency of correspondence with other practitioner types, with rates often concerningly low. Key IPC themes identified were the importance of continuity of care, clarity of communication, and professional practice. CPD participants were most interested in further IPC training (p = 0.001). Conclusions: The IPC resources affirm the role of formal communication pathways, such as letters of correspondence to support coordinated, patient-centred and multidisciplinary care. Challenges with letter writing and IPC signal the need for more student and professional education on the subject to promote continuity of patient care and the delivery of high quality, integrative medicine and health care services.
... 4 Such concurrent use carries both direct (e.g., drug interactions) 6 and indirect risks (e.g., unnecessary financial expenditure). 7 It is estimated that between 7.5% and 10.4% of hospitalisations occur from adverse drug events in developed countries, and between 28% and 56% are preventable. 8 Patient safety relating to concurrent complementary medicines and pharmaceutical drug use requires adequate communication between patients and their health care providers, as well as between providers. ...
Article
Background Non-disclosure of conventional medicine use to complementary medicine health professionals may result in patient harm. Currently, no standardised validated instrument is available to measure reasons for conventional medicine disclosure or non-disclosure. Objective The aim of this study was to develop and evaluate a multidimensional index for identifying reasons for conventional medicine disclosure and non-disclosure by patients. Methods Drawing upon a sub-sample of the Complementary and Alternative Medicine Use Health Literacy Disclosure Study (N = 520), a formative measurement approach was used to develop a Conventional Medicine Disclosure Index (CONMED-DI). Variance-based structural equation modelling employing partial least squares evaluated multicollinearity, significance and relevance of the formative indicators to their associated primary constructs. Results The CONMED-DI demonstrated adequate construct validity suggesting the CONMED-DI is a pragmatic measure to determine the reasons why people choose to disclose (or not) their conventional medicine use. The CONMED-DI contains 2 second-order measurement models, both with three sub-domains. Conclusion The CONMED-DI serves as a preliminary instrument primarily of value to researchers interested in exploring the complementary medicine clinical encounter. The development of targeted interventions that promote disclosure of conventional medicine can be facilitated through understanding patients' reasons for disclosure and non-disclosure and optimise patients’ safe use of medicines.
... Why such communication is limited within conventional healthcare is unknown. Wardle and Adams [29] found that patients did not communicate about CAM due to fear of disclosure in case of a negative response from conventional healthcare providers. Expected disapproval of CAM use was also given as a reason for this non-communication by Jong et al. [30], but they also found a desire for communication about CAM among participants in their study. ...
Article
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Background It has been suggested that the combination of complementary and alternative medicine (CAM) with conventional medicine carries a risk of adverse effects. The prevalence of CAM usage among patients in the Swedish emergency department (ED) is unknown. Hence, the aim of this study was to investigate CAM use among visiting patients at a Swedish ED. Method A cross-sectional descriptive study was performed between August and October 2016 at an ED in Sweden. The questionnaire included 16 items regarding CAM use, factors associated with CAM use and patient healthcare communication and was distributed to 1600 patients. Results A total of 1029 questionnaires was returned (RR 64.3%). Current CAM use was reported by 7.9%, during the last year by 38.0%, and within lifetime by 72.9%. Factors associated with CAM use were: being a woman, middle-aged, in full-time employment, with secondary education level, higher use of non-prescription drugs and lower use of prescription drugs. Patient healthcare personnel communication about CAM was found to be approximately 5%. Conclusion CAM usage exists among patients visiting Swedish EDs and almost one in ten uses CAM on the same day as the ED visit. CAM usage is associated with demographic factors. However, communication about CAM usage with ED personnel is poor.
... Finally, while it is clear that mobile phones are becoming increasingly important in shaping the local health care delivery, the findings also agree with Hampshire et al., (2016) that the informal use of the technology in the plural health system comes with serious risks for patients. The research data suggest that perceived ease of mobile phone use to simultaneously seek healthcare from multiple biomedical and traditional providers at random meant that patients are at risk of duplicating care treatment, misdiagnoses, incorrect medication, false consultation from unqualified practitioners and questionable mobile phone treatment and care advices (Wardle and Adams, 2014). For example, the participants expressed instances where misdiagnoses and advices received through mobile phones result in economic risks and health complications for patients. ...
Article
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The possibility to use mobile phones to provide affordable, effective and accessible healthcare solutions has continued to attract significant investments in the application of formal m-health schemes in Africa. However, while the formal m-health schemes in Africa are limited and benefited only a handful of people, a majority of individuals are using their own phones to create an informal m-health ecosystem in an attempt to bridge primary healthcare access gaps. This paper draws on qualitative data from a four-year (2012-2016) anthropological study involving marginalised groups in Sierra Leone to document these health-seeking practices along with the benefits and challenges they create in a complex plural health system. It argues that the informal integration of mobile phones into the plural health system offers opportunities for marginalised individuals to search and secure primary healthcare of their choices, but poor network connectivity, high out of pocket maintenance costs, low digital literacy skills, and the lack of policy to streamline and regulate the practices can promise the effectiveness of the informal m-health system. It concludes by offering suggestions for addressing these challenges in the Sierra Leone context.
... Given the prevalence and potential serious consequences of undiagnosed and untreated post-natal depression, such symptoms should be medically assessed [52]. It has been reported that T/ CM use has been associated with delaying proper treatment or masking certain symptoms, resulting in both direct and indirect risks or even harm [53]. The effective management of blocked milk ducts is important in the prevention of mastitis further reiterating the need for women to be fully informed about both the nature of the condition and the limitations of any treatments they may use including T/CM. ...
Article
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Abstract Background There is a long history of traditional/complementary medicine (T/CM) use by women during lactation. While it is important to evaluate such use within a scientific paradigm to ensure efficacy and safety, knowledge about the prevalence and characteristics of T/CM use during lactation is limited. This study aimed to generate preliminary data on the prevalence, perceptions and behaviors related to T/CM use by women living in Macau during lactation. Methods Between April to June 2018, women aged 18 years or above who had breastfed within the previous 12 months were invited to complete a questionnaire which asked about their perceptions and behaviors related to the use of T/CM while breastfeeding. Chi-square analysis and logistic regressions were used to conduct data analysis. Results A total of 500 women completed the survey with 62.6% (95% CI 58.37–66.83) reporting use of at least 1 T/CM while breastfeeding. Of these 48.9% (95% CI 44.67 to 53.13) believed T/CM were safe to take during lactation and 55.6% (95% CI 51.37 to 59.83) suggested there were inadequate resources to assist making an informed decision. Working status, monthly family income and the presence of a breastfeeding-related health problems were associated with T/CM use (all p
... Overall NHPs are low risk, can be beneficial and are generally safe, when manufactured in accordance with good manufacturing practices and used as recommended [4][5][6][7][8]. However, adulteration, whereby products contain substances that are not declared on the label but were intentionally added during manufacture, can raise the risk associated with NHP use [3,[9][10][11][12][13][14][15][16]. ...
Article
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Introduction: The U-Dream line of products are marketed as natural health product sleep aids in Canada and as dietary supplements in the United States. Several user reviews of the product mention concerning side effects not typically associated with the listed herbal ingredients stated on the product label. Based on these concerns an analytical study was undertaken to determine if the products contained any undeclared pharmaceuticals. Methods: Product was screened by high resolution mass spectrometry (HRMS) for known pharmaceuticals with sedative and sleep promoting properties. Based on the mass spectral screens an unknown compound was isolated for characterization by nuclear magnetic resonance (NMR) and presence confirmed by Enzymelinked Immunosorbent Assay (ELISA). Results: The mass spectral analyses indicated the presence of an undeclared analogue of the pharmaceutical drug zopiclone within the product lot tested. NMR characterization confirmed the compound to be a brominated analogue of zopiclone and a commercial zopiclone/eszopiclone ELISA kit tested positive. Discussion: The undeclared compound was found to be an analogue of zopiclone whereby the chlorine atom was substituted with bromine. Given the results of the ELISA assay and the structural similarity to zopiclone it is likely the compound exhibits biological activity. Of considerable concern is not only the potential of the unknown compound to exhibit pharmacological activity, but the lack of a safety profile by which the risk can be properly assessed. Conclusions: The natural health product regulations provide a framework for high quality, safe and efficacious products to access the market. It is the responsibility of the manufacturer to assure traceability and transparency in their supply chain and establish verifiable compliance with GMP. This study illustrates the importance of careful evaluation of analytical data in order to detect undeclared adulterants and highlights the need for an active monitoring and surveillance system for potentially high-risk products.
... EVD survivors also mentioned a lack of access to a qualified T&CM practitioner as a barrier to using T&CM. The lack of access to a qualified T&CM practitioner may stem from the fear that receiving advice about T&CM use from unqualified people (relatives, friends, and street vendors) can lead to patient harm given that they lack evidenced based knowledge about T&CM [50,60]. The Government of Sierra Leone emergency response regulatory prohibition of T&CM practitioners from treating Ebola patients or EVD survivors and, given their perceived lack of knowledge about EVD [61], the fear of contracting EVD among T&CM practitioners may explain EVD survivors' lack of access to a qualified T&CM practitioner. ...
Article
Background and Purpose This study explores Ebola survivors' healthcare-seeking experiences within the context of Sierra Leone's free healthcare initiative (FHCI) and comprehensive package for Ebola survivors (CPES) program while also exploring the enablers and barriers to their use of informal healthcare. Materials and methods We employed an inductive, exploratory qualitative approach using focus group discussion with 41 adults Ebola survivors in the four administrative regions of Sierra Leone. Results Biomedical care was the first choice of treatment option for most survivors immediately following post-ETC discharge. Survivors' healthcare-seeking experience varies before and after their inclusion into FHCI and the establishment of the CPES program. Personal and health system factors influenced survivors’ decision to seek multiple healthcare approaches, especially T&CM. Conclusion Our findings suggest the determinants of Ebola survivors’ healthcare-seeking experiences should be considered when developing and implementing programs aimed at improving the current health status of Ebola survivors in Sierra Leone.
... Despite perception that TCIM is natural and safe, there is some degree of risk. This may be direct (e.g., drug-herb interaction), indirect (e.g., delayed diagnosis or treatment 4,5 ) or financial risk, as most TCIM use incurs out-of-pocket costs. However, some TCIM practices, such as acupuncture and mind-body therapies, demonstrate excellent safety and efficacy profiles. ...
Article
Objectives: To engage with local primary care stakeholders to inform the model of care for a proposed academic integrative health care center incorporating evidence-informed traditional, complementary, and integrative medicine (TCIM) in Sydney, Australia. Design: In-depth semistructured interviews, informed by community-based participatory research principles, were conducted to explore primary care stakeholder preferences and service requirements regarding the proposed Western Sydney Integrative Health (WSIH) center in their local district. Setting: Telephone and face-to-face interviews at primary care clinics in Sydney. Subjects: Thirteen participants took part in the study: eight general practitioners (GPs) and five primary care practice managers (PMs). Methods: GPs were recruited through local GP newsletters, closed GP Facebook groups, and snowballing. PMs were recruited through a national PM newsletter. The semistructured interviews were audiorecorded and transcribed verbatim before conducting a thematic analysis. Results: Three main themes emerged: (1) the rationale for "why" the WSIH center should be established, (2) "what" was most important to provide, and (3) "how" the center could achieve these goals. Participants were willing to refer to the service, acknowledging the demand for TCIM, current gaps in chronic disease care, and negligible Government funding for TCIM. They endorsed a model of care that minimizes out-of-pocket costs for the underserved, incorporates medical oversight, integrates evidence-informed TCIM with conventional health care, builds trust through interprofessional communication and education, and provides sound clinical governance with a strong focus on credentialing and risk management. It was proposed that safety and quality standards are best met by a GP-led approach and evidence-based practice. Conclusions: Our findings demonstrate that participants acknowledged the need for a model of care that fits into the local landscape through integrating conventional health care with TCIM in a team-based environment, with medical/GP oversight to ensure sound clinical governance. Findings will be used with input from other stakeholder groups to refine the WSIH model of care.
... Despite popular perception that T&CM is natural and therefore safe, its use is not completely without concern with potential direct and indirect risks involved [8][9][10][11]. Further, the level of evidence for efficacy and effectiveness of T&CM is mixed. Notwithstanding, some T&CM has amassed moderate or high levels of evidence to support their use [12,13] and have been incorporated into conventional clinical guidelines globally and in Australia [14,15]. ...
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Background: In response to high demand and the growing body of evidence for traditional and complementary therapies, the practice of integrative medicine and integrative healthcare has emerged where these therapies are blended with conventional healthcare. While there are a number of academic integrative healthcare centres worldwide, there are none in Australia. Western Sydney University will soon establish an academic integrative healthcare centre offering evidence-informed traditional and complementary therapies integrated with conventional healthcare in a research-based culture. The aim of this study was to explore healthcare consumers' views about the perceived need, advantages, and disadvantages of the proposed centre and its relevance to community-defined problems and health and service needs. Methods: Qualitative methods, informed by community-based participatory research, were used during 2017. Focus groups supplemented with semi-structured interviews were conducted with healthcare consumers. Participants were recruited through paid advertisements on Facebook. Thematic coding, informed by an integrative healthcare continuum, was used to analyse and organise the data. Analysis was augmented with descriptive statistics of participant demographic details. Results: Three main themes emerged: (i) the integrative approach, (i) person-centred care, and (iii) safety and quality. Participants proposed a coordinated healthcare model, with perspectives falling along a continuum from parallel and consultative to fully integrative models of healthcare. The importance of multidisciplinary collaboration and culturally appropriate, team-based care within a supportive healing environment was emphasised. A priority of providing broad and holistic healthcare that was person centred and treated the whole person was valued. It was proposed that safety and quality standards be met by medical oversight, evidence-informed practice, practitioner competency, and interprofessional communication. Conclusions: Our findings demonstrate that participants desired greater integration of conventional healthcare with traditional and complementary therapies within a team-based, person-centred environment with assurances of safety and quality. Findings will be used to refine the model of care for an academic integrative healthcare centre in Western Sydney.
... Fear of being judged or not receiving care as well as lack of inquiry from healthcare providers were cited as the main reasons for non-disclosure amongst our study participants, and this mirrors findings of studies conducted among general and sub-health populations across Africa. [2] Given that there is an established relationship between non-disclosure of T&CM use and patient safety, [46] educational interventions targeting healthcare practitioners providing care to survivors will be useful in attracting attention and improving knowledge about T&CM use in the care for Ebola survivors [47]. Even in cases, where survivors disclose their T&CM use, our finding indicates that healthcare providers' response was discouraging mirroring findings from a study conducted among HIV/AIDS patients in South Africa [48]. ...
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Background It is well established that Ebola Survivors experience a myriad of physical and psychological sequelae. However, little is known about how they seek care to address their health needs. Our study determines the current healthcare seeking behaviour among Ebola survivors and determines the prevalence, pattern of use and correlates of traditional and complementary medicine (T&CM) use among Ebola survivors in Sierra Leone. Methods We conducted a nationwide questionnaire survey among a cross-sectional sample of Ebola Survivors in Sierra Leone between January and August 2018. We employed descriptive statistics, chi-square test, Fisher exact two-tailed test and backward stepwise binary regression analysis for data analysis. A p-value less than 0.05 was considered statistically significant. Results Ebola Survivors who participated in our study (n = 358), visited a healthcare provider (n = 308, 86.0%), self-medicated with conventional medicines (n = 255, 71.2%) and visited a private pharmacy outlet (n = 141, 39.4%). Survivors also self-medicated with T&CM products (n = 107, 29.9%), concurrently self-medicated with conventional and T&CM products (n = 62, 17.3%), and visited a T&CM practitioner (n = 41, 11.5%). Almost half of (n = 163, 45.5%) Ebola survivors reported using T&CM treatments for post ebola related symptoms and non-Ebola related symptoms since their discharge from an Ebola treatment centre. Ebola survivors who considered their health to be fair or poor (AOR = 4.08; 95%CI: 2.22–7.50; p<0.01), presented with arthralgia (AOR = 2.52; 95%CI: 1.11–5.69, p = 0.026) and were discharged three years or less (AOR = 3.14; 95%CI: 1.13–8.73, p = 0.028) were more likely to use T&CM. Family (n = 101,62.0%) and friends (n = 38,23.3%) were the common sources of T&CM information. Abdominal pain (n = 49, 30.1%) followed by joint pain (n = 46, 28.2%) and back pain (n = 43, 26.4%) were the most cited post–Ebola indications for T&CM use. More than three-quarters of T&CM users (n = 135, 82.8%) failed to disclose their use of T&CM to their healthcare providers. Conclusion Ebola survivors in Sierra Leone employ a myriad of healthcare options including T&CM in addressing their healthcare needs. Researchers, health policy makers and healthcare providers should be aware of the substantial role of T&CM in the health seeking of survivors, and this topic that should be factored into future research, policy formulation and implementation as well as routine practice regarding Ebola survivors.
... The belief that herbal remedies can't hurt and may just help make some more willing to experiment with them than they would with pharmaceutical drugs [28,29]. Worse, consumers with serious conditions have been known to risk their lives by using HS instead of conventional healthcare [30]. ...
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Background: The rise in use of food supplements based on botanical ingredients (herbal supplements) is depicted as part of a trend empowering consumers to manage their day-to-day health needs, which presupposes access to clear and accurate information to make effective choices. Evidence regarding herbal supplement efficacy is extremely variable so recent regulations eliminating unsubstantiated claims about potential effects leave producers able to provide very little information about their products. Medical practitioners are rarely educated about herbal supplements and most users learn about them via word-of-mouth, allowing dangerous misconceptions to thrive, chief among them the assumption that natural products are inherently safe. Print media is prolific among the information channels still able to freely discuss herbal supplements. Method: This study thematically analyses how 76 newspaper/magazine articles from the UK, Romania and Italy portray the potential risks and benefits of herbal supplements. Results: Most articles referenced both risks and benefits and were factually accurate but often lacked context and impartiality. More telling was how the risks and benefits were framed in service of a chosen narrative, the paucity of authoritative information allowing journalists leeway to recontextualise herbal supplements in ways that serviced the goals and values of their specific publications and readerships. Conclusion: Providing sufficient information to empower consumers should not be the responsibility of print media, instead an accessible source of objective information is required.
... To further understand T&CM safety, it is also important for researchers to take into consideration the fact that the risk of T&CM needs to be viewed through a wider lens of missed opportunity for known safe and effective treatments, or following advice from poorly trained health professionals in an unregulated environment [43]. Findings from studies such as ours can inform regulatory and policy frameworks, the designing of public health messages and the nature of provider-patient communication regarding T&CM use; all geared towards ensuring safe and informed care for Ebola survivors. ...
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Background and objectives: In addition to conventional healthcare, Ebola survivors are known to seek traditional and complementary healthcare (T&CM) options to meet their healthcare needs. However, little is known about the general beliefs of Ebola survivors regarding T&CM and the impact of these beliefs in influencing their decisions around T&CM use. This study examines Ebola survivors' attitudes towards T&CM use in Sierra Leone. Materials and Methods: We conducted a nationwide quantitative cross-sectional study of 358 Ebola survivors in Sierra Leone between January and August 2018. We used descriptive analysis, chi-square tests and backward stepwise binary logistic regression for data analysis. Results: Close to half of the survivors (n = 163, 45.5%) had used T&CM since their discharge from an Ebola treatment centre. Survivors who viewed T&CM as boosting their immune system/resistance were 3.89 times (95%CI: 1.57-9.63, p = 0.003) more likely to use T&CM than those who did not view T&CM as boosting their immune system/resistance. Additionally, survivors who viewed T&CM as having fewer side effects than conventional medicine were more likely to use T&CM [OR = 5.03 (95%CI: 1.92-13.19, p = 0.001)]. Ebola survivors were more influenced to use T&CM based on their personal experience of the effectiveness of T&CM than by clinical evidence [OR = 13.72 (95%CI: 6.10-30.84, P < 0.001)]. Ebola survivors who perceived T&CM as providing them with more control than conventional medicine over their health/body were more likely to use T&CM [OR = 4.15 (95%CI: 1.74-9.89, p = 0.001)] as opposed to those who did not perceive T&CM in this way. Conclusions: Considering the widespread use of T&CM, an understanding of Ebola survivors' attitudes/beliefs towards T&CM is useful to healthcare providers and policymakers with regard to public education and practitioner-survivors communication, T&CM regulation and research in Sierra Leone. Ebola survivors appear to turn to T&CM not only for treatment, but also to fill gaps in conventional health care services.
... The inadequate knowledge of CAM among health professionals may put their clients in a risky situation because they would then find information about CAM from unreliable sources [11]. Moreover, a survey of CAM use in 25 countries found that up to 20% of people with severe mental disorders rely only on CAM [12]. ...
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Background and objectives: The inadequate knowledge of complementary and alternative medicine (CAM) among health professionals may put their clients at risk because clients would then find information about CAM from unreliable sources. Clinical psychologists (CPs), as health professionals, also have the opportunity to provide psychoeducation on the latest scientific CAM research for their clients. The current study aimed to explore knowledge and educational needs regarding CAM among CPs in Indonesia because previous studies on exploring CAM knowledge and educational needs regarding CAM were primarily conducted in Western countries. Materials and Methods: Data were collected through semi-structured face-to-face interviews with 43 CPs in public health centers (PHCs) in Indonesia. Most interviews were conducted at the PHCs where the participants worked and lasted for 55 minutes on average. The interview recordings were transcribed and were analyzed using deductive thematic analysis. Results: Five main themes emerged within participants' responses regarding CAM knowledge and educational needs. First (CAM understanding), participants' responses ranged from those with little or no prior knowledge of CAM treatments and uses, to those with much greater familiarity. Second (source of knowledge), participants' access ranged widely in terms of references, from popular to scientific literature. Third (why is it important?), participants identified CAM as an essential part of Indonesian culture and considered it therefore crucial to have this cultural knowledge. Fourth (the challenges and what is needed?), the challenges for improving participants' knowledge came from personal and institutional levels. Fifth (what and how to learn?), participants advised that only CAM treatments that fit in brief psychotherapy sessions should be introduced in professional training. Conclusions: This qualitative study discovered that CAM was neither well-known nor understood widely. Participants advised that professional associations and health institutions should work together in enhancing knowledge of CAM and incorporating CAM education into psychology education.
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Traditional healers co-exist with orthodox medicine, especially in cases with perceived supernatural causes and during outbreaks of infectious diseases like the Ebola virus disease (EVD) in the North Kivu and Ituri provinces in the Democratic Republic of the Congo (DRC). In this study, we examined the role and potential of involving traditional healers in the national response to the Ebola virus disease outbreak in the DRC. Seventeen community leaders and 20 traditional healers were interviewed. The traditional healers managed symptoms with herbs and were not inclined to refer cases to orthodox healthcare facilities because of their confidence in their ability to handle cases with supernatural causes. The community leaders attested to the acceptance of the traditional healers in the communities, which they attributed to the efficacy of traditional healing, its uncomplicated treatment process, cause of the prolonged cough, as well as cost and the need for secrecy. Traditional healers can be educated to promptly refer cases to Ebola treatment centers for timely diagnosis and appropriate treatment.
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Vaccine hesitancy has become a threat to public health, especially as it is a phenomenon that has also been observed among healthcare professionals. In this study, we analyzed the relationship between endorsement of complementary and alternative medicine (CAM) and vaccination attitudes and behaviors among healthcare professionals, using a cross-sectional sample of physicians with vaccination responsibilities from four European countries: Germany, Finland, Portugal, and France (total N = 2,787). Our results suggest that, in all the participating countries, CAM endorsement is associated with lower frequency of vaccine recommendation, lower self-vaccination rates, and being more open to patients delaying vaccination, with these relationships being mediated by distrust in vaccines. A latent profile analysis revealed that a profile characterized by higher-than-average CAM endorsement and lower-than-average confidence and recommendation of vaccines occurs, to some degree, among 19% of the total sample, although these percentages varied from one country to another: 23.72% in Germany, 17.83% in France, 9.77% in Finland, and 5.86% in Portugal. These results constitute a call to consider health care professionals’ attitudes toward CAM as a factor that could hinder the implementation of immunization campaigns.
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This article explores complementary and alternative medicine (CAM) organisations' legitimation efforts that face extra obstacles as they are subject to more than one institutional logics (hybrids) and operate in a contested organisational space (hostile environment). CAM organisations espouse the health and market logics and their practices are questioned at an institutional level. The study is conducted in Portugal where the legalisation of CAM therapies was a contested process over ten years. Taking an abductive approach and drawing on qualitative interviews, the authors analyse CAM managers' efforts to legitimise their practices and build viable organisations despite hostile conditions. Contrary to prior studies of hybrid healthcare organisations, CAM organisations derive moral legitimacy from the market logic rather than the health logic. The findings show that relationships, trust-building, and consumer education appear to be the primary vehicles for establishing pragmatic legitimacy. Thus, pragmatic legitimacy relies on the health logic. The market logic dominates the pursuit of moral legitimacy through financial sustainability, human capital, marketing communications and partnerships, and advocating complementarity with biomedicine. We propose a model through which organisations use pragmatic legitimacy to enhance moral legitimacy and to create recursive feedback between moral and pragmatic legitimacy on the path to cognitive legitimacy.
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Diabetes Mellitus, affecting nearly half a billion people worldwide, is a substantial global public health issue. Although diabetes predominantly affects men, women with diabetes have specific risks and self-management characteristics. Women have a higher risk of either presenting with or developing depression or anxiety, as well as being high users of complementary medicine which can create clinical governance issues. In spite of these known gender differences, limited research has explored gender-specific diabetes care, especially health service use patterns. As increasing attention has turned to supporting people with diabetes to successfully self-manage their diabetes, it is important that we understand how women with diabetes are using health services, and if their specific risk profile is influencing their health care choices. Our study sought to examine the relationship between mental health status and the patterns of conventional and complementary medicine health service use by women diagnosed with diabetes mellitus. Our results showed that women with diabetes and any mental health co-morbidity were more likely to visit their general practitioner more frequently or use herbal medicine than those without a mental health co-morbidity. Women with depression and anxiety were also less likely to consult a physiotherapist and those with anxiety less likely to consult a podiatrist over time when compared to the other mental health groups.
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Introduction Traditional and complementary medicines (T&CM) are predominantly self-selected from retail outlets including pharmacies as part of self-care practices. Concerns about the appropriate and safe use of T&CM products raises questions about ‘should’ and ‘how’ pharmacists could adopt professional responsibilities. There lacks a consensus about the scope of these responsibilities, or the initiatives required to execute them. The aim of this study is to identify an international set of core responsibilities that support pharmacists’ contribution to ensuring the quality and safe use of T&CMs to promote public health. Methods and analysis An international cross-sectional e-survey of pharmacists representing the six WHO regions will be conducted over a 12-month period. Pharmacists will be invited via representative organisations and professional networks within their respective country. Survey responses to statements about the relevance of T&CM to day-to-day practice; opinions about the bioethical and practice responsibilities; and support required to build their scope of practice associated with T&CM will be collected centrally via the online survey platform Survey Monkey and analysed using the Statistical Package for Social Sciences V.27 software for Windows. Bivariate statistical analysis will be conducted to examine the associations between agreement to statements within each section with key demographic variables, country of practice, pharmacy type, age, gender, qualification and years in practice. Cronbach’s alpha will be used to test the internal consistency of items from certain sections of the survey and evince their clarity to respondents of the questionnaire. Ethics and dissemination Ethics approval has been obtained from the University of Macau (approval number SSHRE21-APP068-ICMS-01). The results of this survey will be used to inform key discussion points in a consensus process and a step towards developing an agreed and defined professional role for pharmacists in T&CMs.
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Introduction According to international literature, patients with cancer wish to have information on complementary and integrative healthcare (CIH). Medical guidelines recommend actively approaching patients with cancer discussing potential benefits and risks of individual CIH methods. While some CIH methods, for example, acupuncture and yoga, have been proven effective in high-quality studies, other CIH methods lack studies or bear the risk of interactions with chemotherapeutics, for example, herbal drugs. Therefore, an evidence-based interprofessional counselling programme on CIH will be implemented at four Comprehensive Cancer Centres in the federal state of Baden-Wuerttemberg, Germany. Methods and analysis A complex intervention consisting of elements on patient, provider and system levels will be developed and evaluated within a multilayer evaluation design with confirmatory evaluation on patient level. Patients with a cancer diagnosis within the last 6 months will receive three individual counselling sessions on CIH within 3 months (=intervention on patient level). The counselling will be provided by an interprofessional team of medical and nursing staff. For this purpose, an intensive online training programme, a CIH knowledge database and an interprofessional team-building process were developed and implemented (=intervention on provider level). Moreover, training events on the basics of CIH are offered in the outpatient setting (=intervention on system level). Primary outcome of the evaluation at the patient level is patient activation measured (PAM) with the PAM-13 after 3 months. Secondary outcomes, for example, quality of life, self-efficacy and clinical parameters, will be assessed at baseline, after 3 months and at 6 months follow-up. The intervention group (n=1000) will be compared with a control group (n=500, treatment as usual, no CIH counselling. The outcomes and follow-up times in the control group are the same as in the intervention group. Moreover, the use of health services will be analysed in both groups using routine data. A qualitative-quantitative process evaluation as well as a health economic evaluation will identify relevant barriers and enabling factors for later roll-out. Ethics and dissemination The study has been approved by the appropriate Institutional Ethical Committee of the University of Tuebingen, No. 658/2019BO1. The results of these studies will be disseminated to academic audiences and in the community. Trial registration number DRKS00021779; Pre-results.
Article
Background and purpose: Naturopathic practitioners (NPs) in the United States (US) and Australia are consulted for the prevention and management of a range of health conditions, including cardiovascular disease (CVD). Despite this, little is known about how NPs approach the management of CVD risk factors. The aim of this study was to explore NPs approach to the care of people with CVD risk factors. Materials and methods In 2018, Australian and US NPs were recruited via professional representative organisations. A survey was developed containing four domains; naturopathic approaches to the clinical management of CVD risk factors, communication and sharing of information; professional-client relationship factors; and demographic information. The data analysis was conducted using the appropriate statistical tests. Results A total of 151 NPs completed the survey (Australia n = 75, US n = 76). NPs reported employing dietary, and multiple behavioural and natural product interventions to treat CVD risk factors. The most frequently recommended products by US and Australian NPs were fish oils (87%), magnesium (83%) and coenzyme Q10 (87%). Differences in what US and Australian NPs recommended were identified. NPs reported limited communication with medical doctors about their clients. NPs placed high importance on the relationship quality with their clients. Conclusion US and Australian NPs represent an aspect of primary care and disease prevention that warrants further research that evaluates the potential risks and benefits of NP care, and challenges and opportunities associated with NPs integration into the healthcare systems, for populations with CVD risk factors.
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Background: Complementary and alternative medicine (CAM) use is on the increase globally and there is an increased rate of usage among hypertensive patients. Objective: This study was designed to describe CAM use among hypertensive patients at a municipal hospital. Methods: A cross-sectional survey of hypertensive patients at a Municipal Assembly Hospital was conducted. Respondents were made up of 209 (99 CAM users and 110 non-Cam users) selected randomly from patients attending the hypertension clinic. The pattern of CAM use, clinical profiles of respondents, and their attitudes toward CAM were examined. Descriptive statistics and the Chi Square test were used for data analysis. Results: Out of the 209 patients interviewed, 99 (47.36%) had used at least one type of CAM mostly herbal products (72.72%, n =72).The CAM users demonstrated poorer adherence to antihypertensive medications (30.30%, n =30) as compared to non-CAM users (8.08%, n = 80). We observed a positive association between non-CAM use and medication adherence (p = 0.001). The majority (72.72%, n = 72) of the CAM users claimed to have obtained the expected effect, however,89.89% (n = 89) did not disclose their CAM use to their physician. They cited lack of inquiry by physicians as the main reason for non-disclosure. Conclusion: A considerable proportion of hypertensive patients receiving conventional treatment at a municipal hospital also use CAM therapies. Physicians should be encouraged to inquire about the history of CAM use among their patients to be able to advise patients concerning the possible adverse reactions and drug interactions.
Article
Background Conventional healthcare professionals have insufficient knowledge about complementary/alternative medicine (CAM) and often lack competencies to overcome attitudinal barriers to communicate effectively with patients about CAM. Interacting with a virtual simulation-based educational application program may help nurses learn current evidence and acquire communication skills when consulting with patients. Objectives The aim of this pilot study was to evaluate nurses' attitudes towards patients' CAM use and their competency in communicating with patients about CAM after interacting with a virtual simulation-based educational app. Design A quasi-experimental study with one-group, pretest-posttest design. Methods A total of 49 nurses volunteered to participate in the study. Participants interacted with a virtual simulation software app on a smartphone that included audiovisual presentations about CAM, 13 exercises, and a risk-benefit decision assessment. Data about nurses' attitudes and communication competency were collected at baseline and after completing the 13 exercises. Descriptive and comparative statistics were analyzed using the IBM® SPSS® version 22.0. Results Both the nurses' attitudes about patients' CAM use and communication competency improved significantly following the completion of the 13 exercises. The risk-benefit decision scores correlated significantly with the increase in nurses' attitudes and their communication competency. Conclusions Using a virtual simulation-based educational app may help nurses not only increase their attitudes towards CAM but also increase their communication competency in consulting with patients about CAM use.
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This article explores possible legitimacy-building mechanisms for social enterprises with difficult-to-measure outcomes and hostile contexts. Interviews were developed with managers of enterprises offering complementary and alternative medicine (CAM) services, taken as an example of social enterprises in a hostile context. Our findings indicate that CAM enterprises rely on relationship building and consumer education to establish pragmatic legitimacy; the quest for moral legitimacy is expressed through the hybrid organizational form, human capital and professionalization attempts, formalization of procedures, and strategic alliances. Building on Suchman’s (Academy of Management Review 20:371–610) three levels of legitimacy, we propose a mechanism through which enterprises use pragmatic legitimacy to enhance moral legitimacy and to create a feedback effect between moral and pragmatic legitimacy so that ultimately cognitive legitimacy can be achieved.
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Introduction: The objectives of this work were: 1) to develop and validate a questionnaire to understand several dimensions of the use of CAM practitioners in France and 2) to evaluate the test-retest reliability of each of its items.Purpose of research: Development and validation (face validity): A questionnaire was created and then analyzed by 7 experts, including 3 social scientists. Before finalization, the questionnaire was tested on a sample of 43 individuals via cognitive interviews. Test-retest reliability: 322 individuals completed the questionnaire twice (at least 9 days apart). The reliability of the 107 categorical variables that compose the questionnaire was assessed by unweighted Gwet's AC1 coefficient. Results: A short and clear questionnaire, suitable for collecting the targeted information, was methodically developed. In total, excluding descriptive items characterizing the population, the questionnaire includes 114 items, 107 of which are closed and 7 open. 107 of these items are conditional. The average filling time was less than 3 minutes. Of the 107 categorical items, 1 item was associated with moderate test-retest reliability, 9 items with good reliability and 97 with very good reliability. Conclusion: A reliable and valid questionnaire to evaluate the use of CAM practitioners in France is available. It may allow the collection of data necessary to assess the public health issue that this phenomenon represents.
Article
Objectives: To test the dissatisfaction hypothesis by focusing on the use of CAM practitioners by low back pain patients. Moreover, we have distinguished between the complementary use and the alternative use of a CAM practitioner to medical care. Methods: We conducted a cross-sectional study of a sample of 2,056 adults living in metropolitan France. Results: The likelihood of the alternative use of a CAM practitioner decreased with increasing satisfaction with the general practitioner (OR: 0.990, 95% CI 0.984-0.996). The likelihood of the complementary use of a CAM practitioner (excluding osteopaths) decreased with increasing satisfaction with medical care (OR: 0.984, 95% CI 0.972-0.996). Conclusions: Our results support the dissatisfaction hypothesis to explain the use of CAM practitioners for low back pain, whether this use is alternative or complementary to medical care. However, concerning the complementary use, our study shows that this hypothesis is invalid for osteopaths.
Article
Background: Some pediatric patients with attention-deficit/hyperactivity disorder (ADHD) use natural health products (NHPs) such as herbal remedies. Although herbal remedies are generally considered to be safe when they are used appropriately, they may contain active components that can interact with medications being used concurrently, with potential for NHP-drug interactions leading to adverse events. Objectives: The objectives of this study were (1) to identify adverse event reports (AERs) involving commonly used herbal remedies and ADHD prescription medicines in children and adolescents; (2) to evaluate the quality of collected AERs; and (3) to assess whether NHP-drug interactions can be causally linked to reported adverse events. Methods: We systematically searched the FDAble database (FDAble.com) for herbal remedies commonly used by patients (4-18 years old) also taking ADHD drugs from 1997 to 2015. We assessed the completeness of the AERs and used three causality assessment tools modified for NHPs (Naranjo Adverse Drug Reaction Probability Scale, HORN Drug Interaction Probability Scale, and World Health Organization Uppsala Monitoring Centre Scale). Results: Of the 23 identified AERs involving both an herbal remedy and an ADHD prescription medication, most involved multiple (>3) substances with inadequate detail to assess multiple potential interactions. Following data extraction and evaluation of completeness, five AERs involving only one herbal remedy and one ADHD medication were evaluated for causality. An NHP-drug interaction was assessed to be probable in one case and to be possible in another. Both these reports involved a methylphenidate formulation and St. John's wort. Conclusions: Eighteen of the 23 identified AERs involving both an herbal remedy and an ADHD drug also involved other multiple ingredient products. The reporting quality was poor for the five AERs examined. Further research is needed to study the interaction between St. John's wort and methylphenidate.
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Background and objectives: The inadequate knowledge of complementary and alternative medicine (CAM) among health professionals may put their clients in risky situation because they then would find information about CAM from unreliable sources. Clinical psychologists (CPs), as health professionals, have also the opportunity to provide psychoeducation on the latest CAM scientific research to their clients. The current study aimed to explore knowledge and educational needs of CAM among CPs in Indonesia because previous studies on exploring CAM knowledge and educational needs of CAM were primarily conducted in Western countries. Materials and Methods: Data were collected through semi-structured face-to-face interviews with 43 CPs in public health centers (PHCs) in Indonesia. Most interviews were held at the PHCs where participants worked and interviews lasted for 55 minutes, on average. The interview recordings were transcribed and were analyzed using deductive thematic analysis. Results: Five main themes emerged within participants’ responses regarding CAM knowledge and educational needs. First (CAM understanding), participants’ responses ranged from those with little or no prior knowledge of CAM treatments and uses, to those with much greater familiarity. Second (source of knowledge), participants’ access ranged widely in terms of references, from popular to scientific literature. Third (why is it important?), participants identified CAM essentially as part of Indonesian culture and it was therefore crucial to have this cultural knowledge. Fourth (the challenges and what is needed?), the challenges for improving participants’ knowledge came from personal and institutional levels. Fifth (what and how to learn?), participants advised that only CAM treatments that fit in brief psychotherapy sessions should be introduced in professional training. Conclusions: This qualitative study discovered that CAM was neither well-known nor understood widely. Participants advised that professional associations and health institutions should work together in enhancing knowledge of CAM and incorporating CAM education into psychology education.
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Abstract Background Growing popularity of complementary and alternative medicine (CAM) in the public sector is reflected in the scientific community by an increased number of research articles assessing its therapeutic effects. Some suggest that publication biases occur in mainstream medicine, and may also occur in CAM. Homeopathy is one of the most widespread and most controversial forms of CAM. The purpose of this study was to compare the representation of homeopathic clinical trials published in traditional science and CAM journals. Methods Literature searches were performed using Medline (PubMed), AMED and Embase computer databases. Search terms included "homeo-pathy, -path, and -pathic" and "clinical" and "trial". All articles published in English over the past 10 years were included. Our search yielded 251 articles overall, of which 46 systematically examined the efficacy of homeopathic treatment. We categorized the overall results of each paper as having either "positive" or "negative" outcomes depending upon the reported effects of homeopathy. We also examined and compared 15 meta-analyses and review articles on homeopathy to ensure our collection of clinical trials was reasonably comprehensive. These articles were found by inserting the term "review" instead of "clinical" and "trial". Results Forty-six peer-reviewed articles published in a total of 23 different journals were compared (26 in CAM journals and 20 in conventional journals). Of those in conventional journals, 69% reported negative findings compared to only 30% in CAM journals. Very few articles were found to be presented in a "negative" tone, and most were presented using "neutral" or unbiased language. Conclusion A considerable difference exists between the number of clinical trials showing positive results published in CAM journals compared with traditional journals. We found only 30% of those articles published in CAM journals presented negative findings, whereas over twice that amount were published in traditional journals. These results suggest a publication bias against homeopathy exists in mainstream journals. Conversely, the same type of publication bias does not appear to exist between review and meta-analysis articles published in the two types of journals.
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The conclusions of The House of Commons Science and Technology Committee report examining the policy on homeopathy, it is a careful and thoughtful analysis. It is the best example of the responsibility of the Parliaments for protects the health right of the patients. His proposals will be valid for all the countries and will be global principle for regulation. It is unacceptable for the National Health Authorities to license placebo products conferring upon them some of the status of medicines. Even if medical claims on labels are prohibited, the official licensing itself lends direct credibility to a product. Licensing paves the way for retail in pharmacies and consequently the patient's view of the credibility of homeopathy may be further enhanced. The Governments runs the risk of endorsing homeopathy as an efficacious system of medicine. It is time to break this chain. Homeopathy should not be funded and the Agencies of Medicaments should stop licensing homeopathic products. Not changes the actual situation will lose the credibility of the Health Institutions. It is one more political inconsistency. © 2011 - Network of Centres for Study of Pharmaceutical Law. All rights reserved.
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The application of consumer Law has become significant in the health sector including the provision of complementary and alternative medicine. Many legal authorities in this area deal with extreme examples of breaches of consumer law which provides a problematic image for the evidence base for this form of health care especially when high quality scientific is sought in regard to representations made. The article discusses the fact that in some contexts traditional use evidence is applied in regard to the determination of appropriate indications of use for the registration and listing of complementary and alternative medicine but this does not appear to be applied in consumer law decisions. The capacity to provide high quality scientific evidence is limited for many form of complementary and alternative medicine based upon their historical background and approach to healing. Based upon an analysis of the value obtained from scientific evidence for complementary and alternative medicine this article argues for a broader use of traditional evidence and other forms of evidence to support compliance with consumer legislation in a context of where public safety is preserved.
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To investigate adverse events attributed to traditional medical treatments in the Republic of Korea. Adverse events recorded in the Republic of Korea between 1999 and 2010 - by the Food and Drug Administration, the Consumer Agency or the Association of Traditional Korean Medicine - were reviewed. Records of adverse events attributed to the use of traditional medical practices, including reports of medicinal accidents and consumers' complaints, were investigated. Overall, 9624 records of adverse events attributed to traditional medical practices - including 522 linked to herbal treatments - were identified. Liver problems were the most frequently reported adverse events. Only eight of the adverse events were recorded by the pharmacovigilance system run by the Food and Drug Administration. Of the 9624 events, 1389 - mostly infections, cases of pneumothorax and burns - were linked to physical therapy (n = 285) or acupuncture/moxibustion (n = 1104). In the Republic of Korea, traditional medical practices often appear to have adverse effects, yet almost all of the adverse events attributed to such practices between 1999 and 2010 were missed by the national pharmacovigilance system. The Consumer Agency and the Association of Traditional Korean Medicine should be included in the national pharmacovigilance system.
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The objective of the research was to map the discourse about herbal medicine in Australia’s primary medical journal, the Medical Journal of Australia, over 4 decades. Manifest content analysis of 148 articles about herbal or complementary and alternative medicine (CAM) in journal articles from 1966 to 2008 was undertaken. Issues of risk dominated the discourse about herbal medicine in the journal (70%), with a focus on adverse events (42%) as the most significant risk of herbal and other complementary medicines. Toxicity (23%) and drug interactions (18%) were the most frequently mentioned specific risk items. Items that acknowledged efficacy (32%) outweighed those suggesting ineffectiveness (11%). Case reports, reviews, research articles, and letters all had risk frequencies of more than 70%. Review articles and research articles had a high rate of reference to both risk and benefit. Review articles were found to have greater reference to benefit than risk. Possible reasons for these findings are discussed.
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We reproduce here the guide to the English editing currently in use at A&A.
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AIMS AND METHOD We assessed the appropriateness of treatments recommended by health shop staff for symptoms of mild-to-moderate depression using participant observation with ten members of staff from ten different health shops selling herbal medicinal preparations. RESULTS A wide range of treatment options were suggested by health shop staff when presented with common symptoms of depression. The majority have no firm evidence base, with the exception of St John’s wort ( Hypericum perforatum ). CLINICAL IMPLICATIONS Most alternative treatments recommended by health shops for the treatment of depression have a poor evidence base. Implications for training and communication between agencies are discussed.
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Background The literature on chiropractic safety tends to focus on adverse events and little is known about how chiropractors ensure safety and manage risk in the course of their daily practice. The purpose of this study was to investigate how chiropractors manage potentially risky clinical scenarios. We also sought to establish how chiropractors perceive the safety climate in their workplace and thus whether there is an observable culture of safety within the profession. Methods An online questionnaire was designed to determine which of nine management options would be chosen by the respondent in response to four defined clinical case scenarios. Safety climate within the respondent’s practice setting was measured by seeking the level of agreement with 23 statements relating to six different safety dimensions. 260 licensed chiropractors in Switzerland and 1258 UK members of The Royal College of Chiropractors were invited to complete the questionnaire. Questionnaire responses were analysed quantitatively in respect of the four clinical scenarios and the nine management options to determine the likelihood of each option being undertaken, with results recorded in terms of % likelihood. Gender differences in response to the management options for each scenario were evaluated using the Mann–Whitney U (MWU) test. Positive agreement with elements comprising each of the six safety dimensions contributed to a composite ‘% positive agreement’ score calculated for each dimension. Results Questionnaire responses were received from 76% (200/260) of Swiss participants and 31% (393/1258) of UK members of The Royal College of Chiropractors. There was a general trend for Swiss and UK chiropractors to manage clinical scenarios where treatment appears not to be successful, not indicated, possibly harmful or where a patient is apparently getting worse, by re-evaluating their care. Stopping treatment and/or incident reporting to a safety incident reporting and learning system were generally found to be unlikely courses of action. Gender differences were observed with female chiropractors appearing to be more risk averse. Conclusions Swiss and UK chiropractors tend to manage potentially risky clinical scenarios by re-evaluating the case. The unlikeliness of safety incident reporting is probably due to a range of recognised barriers, although Swiss and UK chiropractors are positive about local communication and openness which are important tenets for safety incident reporting. The observed positivity towards key aspects of clinic safety indicates a developing safety culture within the Swiss and UK chiropractic professions.
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This overview of systematic reviews (SRs) aims to evaluate critically the evidence regarding the adverse effects of herbal medicines (HMs). Five electronic databases were searched to identify all relevant SRs, with 50 SRs of 50 different HMs meeting our inclusion criteria. Most had only minor weaknesses in methods. Serious adverse effects were noted only for four HMs: Herbae pulvis standardisatus, Larrea tridentate, Piper methysticum and Cassia senna. The most severe adverse effects were liver or kidney damage, colon perforation, carcinoma, coma and death. Moderately severe adverse effects were noted for 15 HMs: Pelargonium sidoides, Perna canaliculus, Aloe vera, Mentha piperita, Medicago sativa, Cimicifuga racemosa, Caulophyllum thalictroides, Serenoa repens, Taraxacum officinale, Camellia sinensis, Commifora mukul, Hoodia gordonii, Viscum album, Trifolium pratense and Stevia rebaudiana. Minor adverse effects were noted for 31 HMs: Thymus vulgaris, Lavandula angustifolia Miller, Boswellia serrata, Calendula officinalis, Harpagophytum procumbens, Panax ginseng, Vitex agnus-castus, Crataegus spp., Cinnamomum spp., Petasites hybridus, Agave americana, Hypericum perforatum, Echinacea spp., Silybum marianum, Capsicum spp., Genus phyllanthus, Ginkgo biloba, Valeriana officinalis, Hippocastanaceae, Melissa officinalis, Trigonella foenum-graecum, Lagerstroemia speciosa, Cnicus benedictus, Salvia hispanica, Vaccinium myrtillus, Mentha spicata, Rosmarinus officinalis, Crocus sativus, Gymnema sylvestre, Morinda citrifolia and Curcuma longa. Most of the HMs evaluated in SRs were associated with only moderately severe or minor adverse effects.
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Delay in seeking treatment at the hospital is a major challenge in current Buruli ulcer control; it is associated with severe sequelae and functional limitations. Choosing alternative treatment and psychological, social and practical factors appear to influence delay. Objectives were to determine potential predictors for pre-hospital delay with Leventhal's commonsense model of illness representations, and to explore whether the type of available dominant treatment modality influenced individuals' perceptions about BU, and therefore, influenced pre-hospital delay. 130 healthy individuals aged >18 years, living in BU-endemic areas in Benin without any history of BU were included in this cross-sectional study. Sixty four participants from areas where surgery was the dominant treatment and sixty six participants from areas where antibiotic treatment was the dominant treatment modality were recruited. Using a semi-structured interview we measured illness perceptions (IPQ-R), knowledge about BU, background variables and estimated pre-hospital delay. The individual characteristics 'effectiveness of treatment' and 'timeline acute-chronic' showed the strongest association with pre-hospital delay. No differences were found between regions where surgery was the dominant treatment and regions where antibiotics were the dominant treatment modality. Individual characteristics, not anticipated treatment modality appeared predictors of pre-hospital delay.
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Background Naturopaths are an increasingly significant part of the healthcare sector in Australia, yet despite their significant role there has been little research on this practitioner group. Currently the naturopathic profession in Australia is undergoing a period of rapid professional growth and change. However, to date most research exploring the perceptions of naturopaths has been descriptive in nature and has focused on those in leadership positions rather than grassroots practitioners. This article explores the perceptions and experiences of practising naturopaths on the challenges and future directions of their profession. Methods Semi-structured interviews were conducted with 20 naturopaths practising in the Darling Downs region of South-east Queensland, Australia to explore current perceived challenges in the naturopathic profession in Australia. Results Participants perceived a number of internal and external challenges relating to the profession of naturopathic medicine. These included a public misconception of the role of naturopathic medicine; the co-option of naturopathic medicine by untrained or unqualified practitioners; the devaluation of naturopathic philosophy as a core component of naturopathic practice; a pressure to move towards an evidence-based medicine model focused on product prescription; the increasing commercial interest infiltrating complementary medicine, and; division and fragmentation within the naturopathic profession. Naturopaths generally perceived government regulation as a solution for many of these challenges, though this may be representative of deeper frustrations and disconnections between the views of grassroots naturopaths and those in professional leadership positions. Conclusions Grassroots naturopaths identify a number of challenges that may have significant impacts on the quality, effectiveness and safety of naturopathic care. Given the significant role naturopaths play in healthcare in Australia the practice and policy implications of these challenges require further research attention.
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Abstract Background There is little known about women’s concurrent use of conventional and complementary health care during pregnancy, particularly consultation patterns with complementary and alternative medicine (CAM). This study examines health service utilisation among pregnant women including consultations with obstetricians, midwives, general practitioners (GPs) and CAM practitioners. Methods A sub-study of pregnant women (n=2445) was undertaken from the nationally-representative Australian Longitudinal Study on Women’s Health (ALSWH). Women’s consultations with conventional practitioners (obstetricians, GPs and midwives) and CAM practitioners for pregnancy-related health conditions were analysed. The analysis included Pearson chi-square tests to compare categorical variables. Results The survey was completed by 1835 women (response rate = 79.2%). A substantial number (49.4%) of respondents consulted with a CAM practitioner for pregnancy-related health conditions. Many participants consulted only with a CAM practitioner for assistance with certain conditions such as neck pain (74.6%) and sciatica (40.4%). Meanwhile, women consulted both CAM practitioners and conventional maternity health professionals (obstetricians, midwives and GPs) for back pain (61.8%) and gestational diabetes (22.2%). Women visiting a general practitioner (GP) 3–4 times for pregnancy care were more likely to consult with acupuncturists compared with those consulting a GP less often (p
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To ascertain the recommendations, training and education of health food store employees and determine how they communicate the costs, benefits and risks associated with natural health products for the HIV/AIDS community. Four male research assistants, posing as asymptomatic HIV-positive individuals, inquired of employees of all retail health food stores in a major Canadian city as to what is recommended for their condition. The research assistants asked about product costs, side effects, potential drug interactions and efficacy. They also inquired as to employee education related to Complementary and Alternative Medicine (CAM) and noted whether employees asked about which conventional medications they were taking and whether they recommended that the subjects seek physician or CAM provider advice. A total of 32 stores were included. Eight store employees (25%) offered no advice; eight (25%) inquired whether the subjects were currently taking medications; six (19%) suggested visiting a physician; and eight (25%) suggested visiting a CAM provider. A total of 36 different products (mean 2.3 per employee) were recommended with considerable variability in product evidence and cost. The education of the employees varied from postgraduate education (n=3), to undergraduate degree (n=3), college level (n=5) in CAM, or no formal education in CAM (n=21). There was considerable heterogeneity in advice on natural food products provided by employees of natural food stores and, in general, these individuals had limited formal training in CAM. The products they recommended had limited evidence supporting their efficacy and in some instances were potentially harmful and had considerable costs. The findings of this study support the need to further examine how best to regulate this growing component of the health care system.
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Background: In May 2006, a multidisciplinary community-based integrative medicine (IM) clinic was established in Sydney, Australia. It was designed to offer a wide range of IM services, for primary care and to serve as a referral center. Objective: The aim of this study was to determine which factors were successful and which ones posed challenges for establishing this kind of clinic. Method: A study of the first 4 years of this primary care integrative medicine clinic was undertaken, using mixed methods--both qualitative and quantitative. Results: Consistent with success factors identified in the literature, the clinic had an open-minded culture, credible supporters, suitable facilities, and clinically competent practitioners. Throughout the 4 years of its existence, the clinic strove to create an economically sustainable environment and to develop the service. As time progressed, it became evident that at least half of the practitioners needed to be biomedical doctors for the practice to remain viable. The challenges encountered were creating an economically sustainable clinic, managing high staff and practitioner turnover, finding the right balance between practitioners and services offered, developing an integrative medicine team, and building research capacity to evaluate the clinic and patient outcomes. Conclusions: Although many integrative medicine clinics fail to survive the first few years, after 4 years, this multidisciplinary primary care clinic had succeeded in establishing a viable health care service offering both integrative medicine and conventional, traditional, complementary, and alternative medicine. Finding the right mix of staff members and following up with evaluations to track progress are important.
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Complementary and alternative medicine (CAM) use for pediatric asthma is increasing. The authors of previous studies linked CAM use with decreased adherence to conventional asthma medicines; however, these studies were limited by cross-sectional design. Our objective was to assess the effect of starting CAM on pediatric adherence with daily asthma medications. We used a retrospective cohort study design. Telephone surveys were administered to caregivers of patients with asthma annually from 2004 to 2007. Dependent variables were percent missed doses per week and a previously validated "Medication Adherence Scale score." Independent variables included demographic factors, caregiver perception of asthma control, and initiation of CAM for asthma. We used multivariate linear regression to assess the relationship between medication adherence and previous initiation of CAM. From our longitudinal data set of 1322 patients, we focused on 187 children prescribed daily medications for all 3 years of our study. Patients had high rates of adherence. The mean percent missed asthma daily controller medication doses per week was 7.7% (SD = 14.2%). Medication Adherence Scale scores (range: 4-20, with lower scores reflecting higher adherence) had an overall mean of 7.5 (SD = 2.9). In multivariate analyses, controlling for demographic factors and asthma severity, initiation of CAM use was not associated with subsequent adherence (P > .05). The data from this study suggest that CAM use is not necessarily "competitive" with conventional asthma therapies; families may incorporate different health belief systems simultaneously in their asthma management. As CAM use becomes more prevalent, it is important for physicians to ask about CAM use in a nonjudgmental fashion.
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Patients who have hormone receptor-positive breast cancer and who are taking aromatase inhibitors (AIs) should understand the benefits and risks of concomitant dietary supplement (DS) use. The International Society for Integrative Oncology (SIO) encourages patients to discuss DS use with their health care practitioners. The objective was to conduct a pilot study rating Internet websites from the perspective of health care practitioners for information about AI-DS interactions. Five (5) Internet websites suggested by SIO were evaluated using the DISCERN instrument rating tool. The available AI-DS information on these websites was rated by 4 evaluators: 2 naturopathic doctors, 1 oncology pharmacy resident, and a pharmacy student. The overall rankings ranged from 1.6 to 3.9, with considerable variability in the type of information available from the websites. The interevaluator rankings of the websites ranged from 0.44 to 0.89. The evaluators consistently found the most reliable, unbiased, and comprehensive information on AI-DS interactions at the Natural Medicines Comprehensive Database and Memorial Sloan-Kettering Cancer Center websites. However, more than one database was needed for provision of optimal patient information on AI-DS interactions. In order to effectively advise patients regarding AI-DS interactions, more than one website should be evaluated to assess the potential efficacy and safety of DS in women whose breast cancer is being treated with an AI.
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Complementary medicine research, including naturopathic medicine research, is plagued with many methodological challenges. Many of these challenges have also been experienced in public health research. Public health research has met these challenges with a long history of multidisciplinary, multimethod, and whole systems approaches to research that may better resonate with the ?real world? clinical settings of naturopathic medicine. Additionally, many of the underlying principles of naturopathic medicine are analogous to the underlying principles and activities of public health, specifically in such areas as health promotion, prevention, patient education, and proactive rather than reactive approaches to disease management and treatment. Future research in the field of naturopathic medicine may benefit from adopting public health research models rather than focusing exclusively on biomedical models. A complementary and collaborative relationship between these fields may provide an opportunity to deliver research that more accurately reflects naturopathic medicine practice, as well as providing the opportunity to improve health outcomes more generally.
Chapter
Complementary and alternative medicine (CAM) can be positively defined as diagnosis, treatment, and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy, or by diversifying the conceptual frameworks of medicine. It is popular, hence doctors should know about it....