The prevalence, characteristics, expenditure and predictors of complementary medicine use in Australians living with gastrointestinal disorders: A cross-sectional study

Prevalence, patterns, and disclosure of complementary and alternative medicine (CAM) use among patients with thyroid diseases: A cross-sectional study in Iran

Introduction

Complementary and alternative medicine (CAM) has gained popularity as a therapeutic approach outside conventional medicine for various medical conditions. This study aimed to assess the prevalence, patterns, and disclosure of CAM use among patients with thyroid diseases in Iran.

Methods

This descriptive-analytic cross-sectional study involved patients with thyroid diseases who were visiting Internal Medicine Clinics in Shiraz. The use of CAM was assessed by employing the Persian edition of the I-CAM-Q (I-CAM-IR) questionnaire.

Results

A total of 343 individuals took part in the study, and 85.4 % of them reported using CAM within the previous 12 months. Medicinal herbs were the most commonly used CAM modality (63 %). CAM use was primarily for enhancing overall well-being. Among self-care CAM practices, praying was the most frequently employed (70 %). Women exhibited a significantly higher CAM utilization rate (four times greater) compared to men (p < 0.001), with herbs being more commonly used by women (p < 0.001). A significant proportion of participants did not inform their physicians about their CAM use, and 46 % experienced significant benefits from using CAM.

Conclusion

This study highlights a high prevalence of CAM use, particularly herbal remedies, among Iranian patients with thyroid diseases.

The Subjective Well-being and Health-Related Quality of Life of Australian Adults with Increased Intestinal Permeability and Associations with Treatment Interventions

Objective: The integrity and function of the gastrointestinal system is important in disease prevention and management. This study aims to describe the management methods used by Australian adults with suspected increased intestinal permeability (IP) and the association with subjective wellbeing (SWB) and health-related quality of life (HRQoL).

Design and Setting: Cross-sectional survey of Australian adults diagnosed with IP or have suspected (undiagnosed) IP.

Outcome Measures: Questionnaire items investigating demographic characteristics, self-reported outcome of IP and treatment methods used to manage IP. Participants' HRQoL and SWB according to the 20-Item Short Form Health Survey (SF-20) and Personal Wellbeing Index-Adult (PWI-A) scale, respectively.

Results: Participants (n = 589) frequently used dietary products (87.9%), dietary supplements (72.9%) and lifestyle therapies (54.6%) for managing IP. Participants had lower (i.e., worse) mean SWB scores for all domains compared to the Australian population (p < 0.001). The number of days IP reported to affect daily living was negatively correlated with SWB and HRQoL (p < 0.001). Participants that reported an improvement in their IP in the previous 12 months were more likely to be treated by a healthcare practitioner (OR = 2.04, p = 0.015), use dietary supplements (OR = 2.66, p = 0.003), participate in vigorous exercise (OR = 2.99, p < 0.001) and employ vagus nerve stimulation (OR = 3.10, p = 0.010). Conversely, they were less likely to consume gluten (OR = 0.35, p < 0.001) or use nonsteroidal anti-inflammatory drugs (OR = 0.35, p = 0.022). Self-reported improvement of IP (β = 10.70, p < 0.001) and use of dietary products (β = 12.12, p = 0.008) were predictors of a higher level of SWB.

Conclusions: Altered IP may pose a greater health burden than previously thought, with poor SWB and HRQoL reported in Australian adults with self-reported IP. Our results highlight the potential clinical relevance and consequence of altered IP, providing the first indication of a possible relationship between altered IP and both SWB and HRQoL.

Health-seeking behaviour, views and preferences of adults with suspected increased intestinal permeability: A cross-sectional survey of Australian adults

Background

The public health consequence of increased intestinal permeability (IP) is currently limited by the lack of patient-centred research. This study aims to describe the health-seeking behaviour of Australian adults with suspected IP.

Methods

A cross-sectional survey of 589 Australian adults who have been diagnosed with IP or have suspected (undiagnosed) IP.

Results

The majority (56.2%) of participants with suspected IP reported self-diagnosing their condition, with the majority (56.7%) of these participants preferring to be assessed using an accurate method by a general practitioner or naturopath. On average, Australian adults with suspected IP spent 11.1 (95% CI: 9.5, 12.8) years between first suspecting IP and receiving a formal diagnosis. Over the previous 12 months, participants spent an average of $699 on consultation fees, $2176 on dietary supplements for the treatment of IP, and an average of $287 on the assessment of IP. Furthermore, participants who find it difficult to live on their available household income spent significantly more (mean=$2963) on dietary supplements compared to participants who find it easy to live on their available household income ($1918) (p=0.015).

Conclusion

The investigation of Australian adults with suspected IP found the majority of participants experienced a considerable length of time between first suspecting IP and receiving a diagnosis of IP. The out-of-pocket expenditure associated with the management of IP suggests a financial burden for people with suspected IP. The results of this study provide novel patient-centred considerations that can be used to inform a clinical practice guideline for the management of IP.

Design characteristics of comparative effectiveness trials for the relief of symptomatic dyspepsia: A systematic review

Background

Dyspepsia represents a symptom domain rather than a diagnostic condition and covers a wide range of complex, underlying pathophysiologies that are not well understood. The review explores comparative effectiveness interventions for the treatment of symptomatic dyspepsia along a pragmatic-explanatory continuum. The aim is to identify relevant design characteristics applicable to future upper gastrointestinal comparative effectiveness research employing integrative medicine.

Methods

Medline, CINAHL, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and WHO Clinical Trials were systematically searched until January 2019. Included articles were original research with two or more comparative intervention arms for the primary outcome; relief of symptomatic dyspepsia. Evaluation of the studies was conducted using the pragmatic-explanatory continuum indicator summary (PRECIS-2) tool.

Results

Thirty-six articles were included in the review. A total of 68 Patient Reported Outcome Measurements (PROMs), utilizing 50 different formats were deployed across the studies. The appraisal process revealed eligibility, flexibility in adherence, flexibility in delivery and organization domains further aligned towards an explanatory design.

Conclusion

This review identified three design characteristics relevant for future comparative effectiveness research for the treatment of upper gastrointestinal disorders in a community setting. Extensive exclusion eligibility criteria limited the generalization of comparative effectiveness study results by removing sub-groups of the target populations more at risk of dyspeptic symptoms. The requirement for entry endoscopy was found to be common and not always pragmatically justifiable. Development of validated PROMs appropriate for a generic application to upper gastrointestinal disorders would be advantageous for future comparative effectiveness research within integrative medicine.