Development of an international questionnaire to measure use of complementary and alternative medicine (I-CAM-Q)

Environmental exposure assessment in the international prospective study of Chronic Kidney Disease of UnceRtain Etiology (CKDu) in Agricultural Communities (CURE) research consortium: Design and protocol development

BACKGROUND

Chronic kidney disease of unknown etiology (CKDu) is a major health concern among outdoor manual workers in rural Central America and South Asia. The CURE study is a prospective longitudinal cohort designed to investigate CKDu's environmental risk factors through standardized exposure assessments, questionnaires, and biological and environmental sample collection.

METHODS

This manuscript details the development of a standardized exposure assessment protocol within the CKDu CURE Consortium. The study recruits adults (18-45 years) from CKDu hotspots across five countries, ensuring proportional representation across three eGFR categories (20-59, 60-89, ≥90 mL/min/1.73m2) and excluding participants with diabetes or other known CKD causes. The CURE study is committed to promptly returning clinically and environmentally relevant test results to participants after analysis.

RESULTS

Exposure assessment includes demographics, healthcare access, nephrotoxic medications, infectious pathogens, and agricultural work conditions (e.g., heat stress, hydration, diet, agrochemicals, toxicants). Biological and environmental samples (water, dust, soil, wristbands) are collected considering seasonal variations. Omics analyses, including metabolomics, will investigate environmental and biological interactions. Statistical analyses will assess relationships between exposures and CKDu onset or progression, incorporating environmental mixture analyses.

CONCLUSION

CURE will provide critical insights into CKDu risk factors, supporting future research and prevention strategies. A comprehensive exposure assessment will enhance understanding of environmental contributors, guiding interventions at individual, workplace, and community levels to mitigate CKDu's impact.

A cross-sectional study on the use of complementary and alternative medicine in insomnia patients referred to psychiatric clinics in Iran

OBJECTIVE

This study aimed to investigate the prevalence and types of Complementary and Alternative Medicine (CAM) utilization among Iranian patients referred to psychiatric clinics with self-reported insomnia. It also sought to explore demographic characteristics, attitude of the patients to CAM, the factors influencing patients' decision to use CAM, and factors thought to be linked to the adoption of CAM in this patient population.

METHODS

A cross-sectional study was conducted between July 2023 and October 2023 on 217 patients at outpatient academic psychiatric clinics affiliated with Shiraz University of Medical Sciences. Data was collected using the Persian version of the international questionnaire to measure use of complementary and alternative medicine (I-CAM-IR), assessing CAM usage, motives, specific modalities, and sources of exposure. Descriptive statistics were employed to analyze demographic characteristics, while Chi-square tests and logistic regression analyses were used to assess associations between demographic factors and CAM usage.

RESULTS

A total of 217 patients were initially recruited for the study; however, 12 participants were excluded due to incomplete or invalid data, resulting in a final sample of 205 participants included in the analysis. Of 205 participants, 68.3% reported CAM use, with herbal medicines (73.6%), Persian medicine (45.7%), vitamins and minerals (43.6%), and cupping (10.7%) being prominent modalities. Significant associations were observed between CAM use and demographic factors such as age (P = 0.006), gender (P < 0.001), education (P = 0.006), occupation (P = 0.002), father and mother education levels (P < 0.001, P = 0.015), and family income (P = 0.019). Most CAM users (78.1%) did not inform healthcare providers about their CAM use, with perceived effectiveness mainly focused on health promotion (80.6%).

CONCLUSION

This study reveals a substantial prevalence of CAM utilization among insomnia patients in psychiatric clinics of Iran, with demographic factors influencing CAM use. Healthcare providers should consider incorporating discussions about CAM into insomnia management strategies and be prepared to address patient preferences for complementary treatments. Future research should further explore the impact and outcomes of CAM utilization in managing insomnia to optimize patient care in psychiatric settings.

Reevaluating the safety of chamomile poultices in ophthalmic care

Introduction

German chamomile [Matricaria recutita L. (Asteraceae)] tea poultices are a common folk remedy in Central and Eastern Europe for treating eye inflammations such as blepharitis and conjunctivitis. This practice often precedes medical consultation and professional advice. Surprisingly, some healthcare professionals, including pharmacists, naturopaths, general practitioners, and pediatricians, recommend it as a primary treatment, particularly among the elderly. However, the ophthalmic use of chamomile lacks scientific validation, and the European Medicines Agency (EMA) and ophthalmic guidelines warn of potential allergic reactions, including life-threatening anaphylaxis.

Methods

This review examines the origins and descriptions of herbal poultices, with a focus on chamomile, by analyzing data from Hungarian and international medical literature. The study highlights the unsanitary production and storage conditions, also the external application of chamomile teas, which increase the risk of infection and contamination.

Results

The findings indicate that chamomile tea poultices pose significant health risks due to potential allergic reactions and microbiological contamination. The study underscores the lack of scientific evidence supporting the ophthalmic use of chamomile and the dangers associated with its application.

Discussion

The implications of these findings are critical for healthcare professionals and guideline developers. The study calls for discontinuing chamomile-based ophthalmic therapies and emphasizes the need for evidence-based practices. Future research should focus on validating the safety and efficacy of herbal remedies and developing guidelines to protect public health.

Prevalence and Patterns of Use of Natural Health Products and Medicines in New Zealand: A Pilot Study Using an Online Market Research Panel

BACKGROUND

Traditional, complementary and alternative medicine (TCAM), including natural health products (NHPs), are used by many consumers to address their [perceived] health needs. While many developed countries have national data on NHPs use, limited information is available for New Zealand (NZ). Current, robust data on the prevalence and patterns of NHPs use in NZ are required.

OBJECTIVE

This project explored the feasibility of conducting a national study and collecting preliminary data on the prevalence and patterns of use of NHPs, including access to and expenditure on NHPs, and of the use of conventional medicines in NZ using a newly designed bespoke questionnaire.

METHODS

An online cross-sectional survey was administered to a sample of the adult population in NZ via an online market research panel in November 2021. Self-reported data on participants' use of NHPs (including photographs of products), consultations with TCAM practitioners and use of conventional medicines were collected. Data on the prevalence and patterns of use of NHPs were analysed and reported using descriptive statistics. Multivariable logistic regression was applied to assess the impact of sociodemographic variables on NHPs, TCAM practitioners and conventional medicines use.

RESULTS

The final sample comprised 992 participants. Sociodemographic data for these participants were comparable to those reported for the NZ Census 2018. The frequency of missing data was < 10% for most of the questions; data quality for broad-level prevalence analysis was good, but was moderate to poor for analysis at the specific NHP or TCAM practitioner level. The specific product(s) and their respective ingredient list(s) could not be determined for most NHPs described as photographs were not uploaded, rendering product names unverifiable. Preliminary data indicate that 57.6% of participants have used NHPs and 22.9% consulted a TCAM practitioner in the last 12 months. Among current NHP users, 71.1% concurrently used one or more conventional medicines. Over half (53%) of the NHPs were self-selected (not recommended by a health practitioner). The median daily cost per NHP was NZD 0.28 (interquartile range NZD 0.14-0.50) and the median cost for visits to a TCAM practitioner over the last 12 months was NZD 120 (interquartile range NZD 40-270). Female participants, younger individuals and conventional medicine users were more likely to use NHPs/consult a TCAM practitioner/use any TCAM. Higher-income participants were more inclined to consult a TCAM practitioner. Individuals born overseas were more likely to use any type of TCAM.

CONCLUSIONS

There was a high prevalence of use of NHPs and of consultations with TCAM practitioners, which may reflect the extent of use in the general NZ population. Recognising the potential impact on patients' health outcomes, there is a need for a larger and nationally representative dataset, preferably linkable to other health data collections, to validate these preliminary findings.

Exploring men's cancer journeys in Norway: a comprehensive survey on diet, supplements, and use of complementary and alternative therapies

BACKGROUND

Each year, over 20,000 men are diagnosed with cancer in Norway, and approximately 150,000 men who have previously been diagnosed with cancer are currently alive. Many of these cancer survivors encounter a range of challenges, including fatigue, sexual dysfunction, urinary issues, and pain, all of which can significantly impact their quality of life. Consequently, a substantial number of men seek support beyond conventional healthcare. This study aims to investigate the motivations behind the use of Complementary and Alternative Medicine (CAM) and dietary changes/supplements in men with cancer in Norway, and further explore their communication with healthcare providers, self-reported effects and adverse effects, and the sources of information they rely on regarding these practices.

METHOD

In collaboration with the Norwegian Cancer Society (NCS), we conducted an online cross-sectional study involving participants of their user panel who have current or past experiences with cancer (n = 706), of whom 218 identified as men. The study was conducted during the autumn of 2021, employing a modified cancer-specific version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). A total of 153 men agreed to participate, yielding a response rate of 70%.

RESULTS

A large proportion of the respondents used CAM (62%), dietary supplements (65%), and/or adjusted their diet (81%) to boost their immune systems and increase their quality of life. The dietary adjustments involved eating more fruits, vegetables, fish, and whole grains. Many participants also used relaxation techniques and visited CAM providers to enhance quality of life. Most participants reported better health outcomes as a result of these interventions. The Internet and healthcare professionals were the main source of information, although many did not disclose their dietary changes and CAM therapy use with healthcare professionals.

CONCLUSION

By leveraging these insights, healthcare providers, policymakers, and researchers can collectively work towards a more holistic and patient-centred approach to cancer care, ultimately improving the overall well-being and quality of life for male cancer survivors.

Use of complementary and alternative medicine (CAM) in Sweden: a cross-sectional survey

AIMS

The aim of this study was to describe the prevalence, associations, and reasons for the use of complementary and alternative medicine (CAM) in Sweden, as well as to further explore possible self-perceived outcomes including adverse effects as well as the sources of information used.

METHODS

Data were collected by a cross-sectional survey, administered by computer assisted telephone interviews, in June 2020 (n = 500), during the first three months of the COVID-19 pandemic. The survey was a modified version of the International Questionnaire to measure use of Complementary and Alternative Medicine (I-CAM-Q) instrument.

RESULTS

63.6% of respondents reported use of CAM. The most common reasons for use were to improve general well-being and/or to treat long-term illness or its symptoms. Very few used CAM to prevent or treat COVID-19. The most used CAMs were natural remedies and dietary supplements (50%), followed by self-help practices (33.2%) and consultation of CAM providers (13%). Women, those of older age (40+), and living in larger cities were more likely to use CAMs compared to the entire sample. Household income or level of education did not predict CAM use. Few adverse effects were reported. The main sources for information were media and the Internet followed by family and friends.

CONCLUSIONS

This study contributes with updated knowledge about Swedish citizens' use of CAM. The results are important to inform health care policy about patterns of CAM use among Swedish citizens.

Use of complementary and alternative medicine (CAM) among people living with Sjögren's: a cross-sectional survey using a modified international CAM questionnaire (I-CAM-Q)

Sjögren's is a chronic autoimmune disease with diverse symptomatology, and varying patient satisfaction with management. Patients with chronic conditions are known to be higher users of complementary and alternative (CAM) practices, yet little information regarding extent of such use exists. This paper describes usage of CAM practices among people living with Sjögren's, encompassing visits to healthcare providers, CAM practitioners, self-administered CAM and self-help practices. We explored both purposes and perceived helpfulness of the various modalities utilised. 296 respondents completed an online survey administered through Sjögren's Research Ireland in 2023. An adapted form of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q) was utilised as the survey instrument. 88.5% of respondents had a formal diagnosis of Sjögren's. The majority (93.6%) were female, across all age groups. Over half (52%) of non-retired respondents were at least partially unable to work due to their diagnosis. Over half of all respondents (58.8%) listed at least one concomitant health problem. Most respondents (248, 83.8%) had used some form of CAM within the preceding 12 months. One-in-four had attended a CAM practitioner, most commonly chiropractors (8.4%) or acupuncturists (7.8%). Conventional healthcare and CAM providers were both consulted more commonly for management of chronic conditions or for well-being than for acute symptom management, although this was particularly stark for CAM consultations. 196 respondents (66.2%) reported use of self-administered CAM, predominantly vitamins/minerals or dietary supplements. 69.9% used various self-care practices, with the most reported being meditation, relaxation techniques and prayer. People living with Sjögren's attend both conventional healthcare providers and CAM practitioners to a high degree and use a diverse range of complementary therapies and practices. Health care professionals need to consider and discuss potential CAM use by this patient cohort and offer evidence-based patient education about therapies and practices encountered.

International college students' perceptions on complementary and alternative medical practices

OBJECTIVE

The purpose of this study was to determine the complementary and alternative medicinal (CAM) choices of international college students in the U.S.

PARTICIPANTS

A total of 192 international college students participated in this study.

METHODS

Participants completed a survey with demographic and background information, such as gender, age, years living in the U.S., country of origin, cultural and religious influences on health decision-making, CAM usage, and the Complementary and Alternative Medicine Beliefs Inventory (CAMBI).

RESULTS

Results showed that there was a significant difference in CAMBI scores and age groups with those in the age groups of 20-29 and 30+ having higher CAMBI scores than those in the 18-19 age group. Participants had high scores on the CAMBI.

CONCLUSION

Overall, participants showed a wide range of CAM usage with most participants indicating a need for CAM options on university campuses.

Use of integrative and complementary practices in Brazil during the COVID-19 pandemic

The SARS-CoV-2 coronavirus pandemic posed an unprecedented challenge to global health. In the context of an overwhelmed healthcare system and the rising demand for alternative strategies to manage stress and anxiety, this study aims to investigate and analyze the use of Integrative and Complementary Practices (ICP) in Brazil during the COVID-19 pandemic, emphasizing their importance in promoting health and well-being. We conducted a cross-sectional study among n = 12,136 Brazilian adults predominantly female, white, under 40 years of age and with a predominantly higher education level between August 24 and December 16, 2020, to assess the use of ICP. An online questionnaire was applied, with questions validated in previous health surveys. The sampling method employed was 'virtual snowball,' post-stratification procedures were used to consider the Brazilian regions, gender, age group, and educational level. The reported prevalence of ICP use was 61.8%, with meditation (28.2%), Reiki (21.7%), herbal medicine (28.2%), and aromatherapy (16.5%) being the most utilized practices. ICPs were more frequently adopted by females, older age groups, individuals with health insurance, and those who practiced social distancing. Health promotion and well-being were the primary reasons for engaging in ICP. The high adherence to ICP during the COVID-19 pandemic in Brazil reflects the population's search for therapeutic alternatives focused on the well-being and mental health. The utilization of ICP indicates the need to integrate these practices into healthcare systems, considering their potential to complement conventional treatment, especially in times of crisis. Public health policies should recognize and facilitate access to such practices to reduce inequities and promote integrative health. This study contributes to the understanding of the role of ICP in a public health crisis, encouraging further investigation into the potential inclusion of these practices in the healthcare system.

PRIO - a prospective integrative oncology registry: trial protocol

Background

Integrative Oncology (IO) - the use of lifestyle modifications, mind-body practices and natural products in oncology - is increasingly asked for by patients. The evidence base of IO is growing and IO measures are included in national guidelines. Still, many questions about IO remain unanswered or still show a poor evidence base.

Method

Data about demography, socioeconomic status, cancer disease and therapy, integrative oncology measures and patient reported outcomes will be collected in regular visits in oncological patients at the University Cancer Center Ulm, Germany. An expansion to further study centers is planned. After one year and at regular intervals, the registry will be evaluated and adapted accordingly.

Discussion

The PRIO registry builds a solid data base to evaluate the use of integrative oncology measures in cancer patients. It includes patient reported outcome measures to investigate quality of life and satisfaction with health services in this population. The registry aims to enhance transparency in IO use and wants to inform future research in IO. The trial has been registered in the German Clinical Trials Register (DRKS) under the ID DRKS00033250 and in the studyBox of the German Cancer Association under the ID ST-U173 on 18th December 2023. The trial was approved by the ethics committee of the University Medical Center Ulm under the number 375/23 on 7th December 2023.

Motivations behind complementary and alternative medicine use in patients with Crohn's disease and ulcerative colitis

Background

Complementary and alternative medicine (CAM) use is common in inflammatory bowel disease (IBD) patients and impacts compliance with conventional treatment. Gastroenterologists should understand the motivational factors of CAM use-factors that push patients away from standard therapy or pull towards CAM. Our study describes the motivations behind CAM use for IBD and evaluates differences between Crohn's disease (CD) and ulcerative colitis (UC) patients.

Methods

Retrospective cohort survey of patients over 18 years old with IBD, evaluated by gastroenterologists at a tertiary care referral centre from January 1 to December 31, 2019. Only patients who reported CAM use were included. Chi-square and independent t-tests were performed and P-value <0.05 was significant.

Results

Of the 230 completed surveys, 193 reported CAM use (CD: 57.5% vs UC: 42.5%). Demographics, disease duration, and hospitalizations were similar, but CD patients had lower SIBDQ scores (CD: 48.1 vs UC: 53.5, P < 0.001). Both groups were largely influenced by their social network to use CAM (CD: 33% vs UC: 31.3%) and did not feel well informed about CAM (87.4%). CD and UC patients had similar push and pull factors. Push factors included lack of improvement (39%) and side effects (20%) with conventional treatment. Pull factors included the desire for a holistic approach (21%) and to improve mood (35%). UC patients wanted a natural approach to treat their IBD, which nearly reached significance (P = 0.049). Most patients hoped fatigue 62.7%, and diarrhoea 61.7% would improve with CAM, but more CD patients wanted to improve their appetite (P = 0.043).

Conclusion

Despite differences in QoL, push and pull motivations for CAM use did not differ between CD and UC patients. Most users do not feel well informed of CAM and ongoing dialogue is important for patient-centred care.

Traditional and Complementary Medicine Use among Cancer Patients in Asian Countries: A Systematic Review and Meta-Analysis

Globally, cancer patients frequently use T&CM during their treatment for various reasons. The primary concerns regarding the use of T&CM among cancer patients are the potential risks associated with interactions between pharmaceuticals and T&CM, as well as the risk of noncompliance with conventional cancer treatments. Despite the higher prevalence of T&CM use in Asia, driven by cultural, historical, and resource-related factors, no prior review has tried to estimate the prevalence and influencing factors of T&CM use and disclosure among cancer patients in this region. This study aims to examine the prevalence and disclosure rates of T&CM use among cancer patients in Asia to assess various factors influencing its use across different cancer treatment settings in Asia. Systematic research on T&CM use was conducted using four databases (PubMed, EMBASE, Web of Science, and CINAHAL) from inception to January 2023. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS). A random effects model was used to estimate the pooled prevalence of T&CM use, and data analysis was performed using Stata Version 16.0. Among the 4849 records retrieved, 41 eligible studies conducted in 14 Asian countries were included, involving a total of 14,976 participants. The pooled prevalence of T&CM use was 49.3%, ranging from 24.0% to 94.8%, and the disclosure rate of T&CM use was 38.2% (11.9% to 82.5%). The most commonly used T&CM modalities were herbal medicines and traditional medicine. Females were 22.0% more likely to use T&CM than males. A subgroup analysis revealed the highest prevalence of T&CM use was found in studies conducted in East Asia (62.4%) and those covered by both national and private insurance (55.8%). The disclosure rate of T&CM use to physicians remains low. Moreover, the factors influencing this disclosure are still insufficiently explored. Since the disclosure of T&CM use is a crucial indicator of patient safety and the quality of cancer treatment prognosis, future research should focus on identifying the determinants of non-disclosure.

How does the role of complementary and alternative medicine in general practice differ between countries? Interviews with doctors who have worked both in Germany and elsewhere in Europe

BACKGROUND

Available data suggest that general practitioners (GPs) in Germany use complementary and alternative medicine (CAM) modalities more frequently than GPs in many other countries. We investigated the country differences perceived by general practitioners who have worked in Germany and in one of four other European countries with regard to the role of complementary and alternative treatments in primary care.

METHODS

In this qualitative study we conducted semi-structured interviews with 12 GPs who had worked both in Germany and Italy, the Netherlands, Norway or the United Kingdom (UK; n = 3 for each of the four countries). Participants were asked how they perceived and experienced country differences regarding health system, relevance of CAM modalities, the role of evidence-based medicine (EBM) and science, and how they handle so-called indeterminate situations. For the analysis, we followed a thematic analysis approach according to Braun and Clarke with focus on themes that cover CAM.

RESULTS

Participants unanimously reported that they perceived CAM to be more relevant in general practice in Germany compared to the other countries. We identified four overarching themes in relation to the perceived reasons for these differences. Firstly, physicians with experiences in countries with a strong EBM and science orientation (Netherlands, Norway and the UK) considered the deeply ingrained view in national healthcare systems and GP communities that CAM modalities are not evidence-based as the main reason for the lower use of CAM by GPs. Secondly, extensive training of communication skills was cited as a reason that reduced the need for CAM in the Netherlands, Norway and the UK. Thirdly, differences in patient expectations and demands were perceived as a factor contributing to greater utilisation of CAM by German GPs compared to the other countries. Finally, country-specific reimbursement mechanisms were considered as a factor influencing the role of CAM in general practice.

CONCLUSIONS

The study results point to major differences between countries with regard to the role of CAM in GP care. Differences in basic attitudes in the discipline of general practice, patient expectations and system conditions appear to play an important role here.

Healthy Lifestyle and Complementary and Alternative Medicine

Having a healthy lifestyle is one of the main personal goals, and multiple behaviors can be used to achieve this goal. However, people do not always develop appropriate health behaviors. One of the consumption alternatives is the use of complementary and alternative medicine (CAM), which has been increasing significantly in recent years, although not always adequately. This study aimed to determine whether CAM use is associated with a healthy lifestyle in Spanish adults. To achieve these objectives, 2486 adults were interviewed as part of the 2018 Barometer of the Centro de Investigaciones Sociológicas about their lifestyle and CAM use. The findings show a relationship between healthy lifestyle and CAM use; our study shows that there are significant differences between people with healthier lifestyles and those with less healthy lifestyles in some of CAM use, such as herbal medicine, meditation, yoga, nutritional therapies, and acupuncture.

Use of Complementary and Alternative Therapies in People with Inflammatory Bowel Disease

Complementary and alternative medicines (CAMs) are frequently discussed by people with Inflammatory Bowel Disease (IBD). The aim of this study is to explore CAM use in Australians with IBD. This cross-sectional study was conducted via an anonymous online survey, predominantly distributed through IBD-specific social media accounts. Data collection occurred over a three-month period in 2021. Descriptive statistics, Chi-Square tests, and binary logistic regression were used to analyse quantitative data. A simple thematic analysis was conducted for qualitative free-text responses. Of the 123 responses, acupuncture (12.2%) and chiropractors (8.9%) were common CAM practitioners accessed. CAM practitioners were perceived to be 'very helpful' compared to mainstream health practitioners. The most common CAM products reported were vitamins (51.2%), probiotics (43.9%), and herbal medicine (30.9%). Common reasons for use were improved perceived improvements to wellbeing or for long-term management of IBD. Females were more likely to access CAM practitioners (OR 12.6, 95% CI 1.62-98.1, p = 0.02). Doctors were the participants' primary source of information (64.2%), although many expressed dissatisfaction with conventional therapy and the desire for a more holistic approach to care. The use of CAMs in this sample was high. Limited research into the efficacy and safety of these therapies may prevent health professionals from discussing their use with patients. Improved communication with health professionals will allow patients to be active partners in their healthcare plans and can heighten patient satisfaction with conventional therapy.

Complementary and Alternative Medicine (CAM) Practices: A Narrative Review Elucidating the Impact on Healthcare Systems, Mechanisms and Paediatric Applications

While research on complementary and alternative medicine (CAM) for the general population is expanding, there remains a scarcity of studies investigating the efficacy and utilisation of CAM practices, specifically in the paediatric population. In accordance with the World Health Organization (WHO), the prevalence of the parental utilisation of CAM in their dependents is estimated to reach up to 80%. This literature review identified broad, heterogeneous, and inconclusive evidence regarding CAM's applications and effectiveness, primarily attributed to variance in sociodemographic factors and differences in national healthcare systems. Additionally, the review identified a lack of consensus and polarised positions among mainstream professionals regarding the mechanisms of action, applications, and effectiveness of CAM. This narrative review presents varied results concerning the efficacy of most CAM therapies and their applications; however, some evidence suggests potential benefits for acupuncture, yoga, tai chi, and massage in improving physical and mental health. Moreover, the available evidence indicates that meditation may enhance mental health, while reiki may only influence patients' perceptions of comfort. In light of the intricate and multifaceted nature of herbal medicine, it is imperative to assess its efficacy on a case-by-case basis, taking into account the specific compounds and procedures involved. This comprehensive review serves as a valuable resource for health professionals, offering guidance for personalised healthcare approaches that consider the values and beliefs of patients, thereby facilitating integrated, evidence-based practices aimed at enhancing the quality of healthcare services and patient satisfaction.

Health needs, treatment decisions and experience of traditional complementary and integrative medicine use by women with diminished ovarian reserve: A cross-sectional survey

BACKGROUND

Women with diminished ovarian reserve (DOR) have fewer eggs than would be expected at their age. It is estimated that 10% of women seeking fertility treatment are diagnosed with DOR. However, the success rate of medically assisted reproduction (MAR) is significantly lower in women with DOR, thus many seek additional approaches.

AIM

To explore the health needs of women with DOR, treatment options and experience of treatment including traditional complementary integrative medicine (TCIM).

METHODS

Anyone with a diagnosis of DOR, living in Australia or New Zealand, aged over 18 were invited to complete an online survey distributed via fertility support networks and social media platforms from April to December 2021.

RESULTS

Data from 67 respondents were included. The main aspects of health that were impacted by DOR were fertility (91.0%) and mental health (52.2%). The main treatment recommended was MAR with most women either currently using MAR (38.8%) or having previously used MAR (37.3%). TCIM was widely used with 88.1% of women utilising supplements, 74.6% consulting with TCIM practitioners, and 65.7% adopting self-care practices. The main reasons for using TCIM were to improve fertility or support pregnancy, and to support general health and well-being.

CONCLUSIONS

Women with DOR have additional health needs apart from infertility, most notably mental health support. The main form of treatment utilised is MAR, despite DOR being challenging for fertility clinicians. TCIM was widely used, and respondents perceived benefits related to improving fertility, supporting pregnancy, or improving well-being through use of acupuncture, meditation, naturopathy, massage, yoga.

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.

Exploring dietary changes and supplement use among cancer patients in Norway: prevalence, motivations, disclosure, information, and perceived risks and benefits: a cross sectional study

BACKGROUND

Cancer is the leading cause of death in Norway, with prostate, breast, lung, and colon cancers being the most prevalent types. Adopting a healthy and varied diet can help reduce cancer risk and recurrence. However, access to dietary counselling remains limited for cancer patients in Norway. This study aimed to investigate the prevalence of dietary supplement use and dietary changes made by cancer patients and survivors. Additionally, it sought to explore the reason(s) for such practices, communication with healthcare providers, sources of information, and reported benefits and potential harms resulting from these changes and supplement use.

METHODS

Conducted in collaboration with the Norwegian Cancer Society (NCS), this online cross-sectional study targeted members of their user panel who had either current or previous cancer (n = 706). The study took place in September/October 2021, utilizing a modified cancer-specific version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). Out of 468 participants (315 women and 153 men), 67.2% consented to participate. Between-group analyses were conducted using Pearson chi-square tests and Fisher exact tests for categorical variables, while independent sample t-tests were applied for continuous variables.

RESULTS

The majority of the participants (97%) reported making changes to their diet (78%) and/or incorporating dietary supplements (73%) in response to their cancer diagnosis. The primary goal of these changes was to strengthen their body and immune system. Almost half of the participants (49%) reported that they found these changes beneficial and discussed them openly with their healthcare providers, with family physicians being the most common point of discussion (25%). Adverse effects were reported by only a few participants, mostly mild. Information about dietary changes and supplements was primarily sourced from the internet or healthcare providers.

CONCLUSIONS

This study highlights that most individuals affected by cancer attribute to dietary adjustment. It also emphasizes the importance of addressing adherence to dietary recommendations and using reliable sources of information. Additionally, the study highlights the potential, yet currently underutilized, role of healthcare professionals in initiating dialogues about dietary interventions to address any unmet needs of patients. Such proactive engagement may contribute to the promotion of reliable sources of information and the prevention of non-evidence-based and potentially harmful diets or supplement adoption.

Assessment of complementary health approaches use in pediatric oncology: Modification and preliminary validation of the "Which Health Approaches and Treatments Are You Using?" (WHAT) questionnaires

OBJECTIVE

Complementary Health Approaches (CHA) are commonly used by children with cancer; however, a few health care providers (HCPs) inquire about the use of CHA. A standardized questionnaire could facilitate such clinical discussions. We aimed to adapt and determine the face and content validity of the "Which Health Approaches and Treatments are you using?" (WHAT) child and parent-report questionnaires in pediatric oncology.

METHODS

An electronic Delphi survey that included children with cancer (8-18 years), parents, and HCPs and CHA researchers was conducted to reach consensus on the content of the WHAT questionnaires in pediatric oncology. Children and parents from the Hospital for Sick Children (SickKids), and HCPs and researchers from the International Society of Pediatric Oncology and Pediatric Complementary and Alternative Medicine Research and Education Network completed the survey. To determine the face and content validity of the questionnaires, two iterative cycles of individual interviews were conducted with purposive samples of children (8-18 years), parents, and HCPs from SickKids.

RESULTS

Consensus was reached on all domains and items of the original WHAT questionnaires after one Delphi cycle (n = 61). For face and content validity testing, the first cycle of interviews (n = 19) revealed that the questionnaires were mostly comprehensive and relevant. However, the paper-based format of the original WHAT was not user-friendly, and generic items were vague and not aimed at facilitating clinical dialogues about CHA use. The WHAT questionnaires were then modified into electronic cancer-specific self- and proxy-report questionnaires including 13 and 15 items, respectively. The second cycle (n = 21) showed no need for further changes.

CONCLUSIONS

The modified electronic cancer-specific WHAT questionnaires showed adequate face and content validity. The next step is to determine inter-rater reliability, construct validity, and feasibility of administration of the modified WHAT questionnaires in pediatric oncology.

Exploring the Use of Traditional Medicines, Natural Health Products and Conventional Medicines: Development and Testing of the New Zealand 'All-Medicines' Questionnaire

INTRODUCTION

Traditional, complementary and alternative medicine (TCAM) are popular healthcare choices among consumers globally. The latest national data on the use of TCAM practitioners in New Zealand (NZ) were collected over a decade ago. Robust data on the use of natural health products (NHPs) and TCAM practices alongside conventional medicines are not yet available in NZ.

OBJECTIVES

This study aimed to develop and test a bespoke questionnaire (All-MedsNZ) that included comprehensive data collection elements exploring NHPs' and conventional medicines' use.

METHODS

This was a questionnaire design study involving expert panel feedback, and engagement with TCAM users, in the development process. This work comprised questionnaire development (stage 1) followed by a questionnaire-testing study (stage 2). The questionnaire was developed on the basis of literature review findings and the research team's expertise. The questionnaire content was then validated by an expert panel comprising practitioners in TCAM and conventional medicine. Then, a two-phase study was utilised to test the questionnaire. Phase 1 involved participants (NHP users) completing the web-based questionnaire and providing feedback by answering probing questions added throughout the questionnaire to evaluate users' comprehension of the questions and to identify issues with the questionnaire. In phase 2, selected participants were interviewed online to gain in-depth insights into issues identified in phase one. Based on these findings, the questionnaire was revised.

RESULTS

The expert panel (n = 9) confirmed the questionnaire had high face and content validity; most original questions were retained. In the questionnaire-testing study, 95 and 27 participants completed the phase 1 and 2 studies, respectively. Most questions achieved a high response rate of ≥ 90%, and participants had no major issues understanding and answering the questionnaire. Problematic questions were those relating to providing product barcodes and photographs, and information on product costs. Most of the NHPs data entered by participants included the brand/generic name, manufacturer/company name, main ingredient(s) and dose form. Generally, these NHP-related data were of acceptable quality. However, information on the main ingredient(s) of products entered by participants was less satisfactory: approximately one-third of the 143 NHPs recorded in the study had the main ingredient(s) missing or incorrectly stated. Interviews with participants reiterated the issues identified in the phase 1 study. The low response rates for some of the questions were partly due to participants' unpreparedness (i.e. not having NHPs/medicines on hand) to complete the questionnaire. In addition, a lack of clarity for the term 'natural health practitioner' led to confusion among some participants.

CONCLUSION

Overall, no major design-, method- or questionnaire-related issues were identified in this development and testing work. The questionnaire demonstrated adequate face and content validity and acceptability among participants. The data collected were reasonably complete and of sufficient quality for analysis. Future studies should pilot the revised All-MedsNZ questionnaire with a larger, nationally representative sample to ascertain its feasibility and utility.

Interdisciplinary Integrative Oncology Group-Based Program: Evaluation of Long-Term Effects on Resilience and Use of Complementary and Alternative Medicine in Patients With Cancer

BACKGROUND

Cancer often causes reduced resilience, quality of life (QoL) and poorer overall well-being. To mitigate these problems, complementary and alternative medicine (CAM) is widely used among patients with cancer. This study aimed to evaluate the long-term effects of an interdisciplinary integrative oncology group-based program (IO-GP) on the resilience and use of CAM in patients with cancer.

METHODS

This was a prospective, observational, single-center study. Resilience (RS-13), CAM usage (I-CAM-G), QoL (SF-12) and health-related lifestyle factor (nutrition, smoking, alcohol consumption and physical exercise) data were collected for 70 patients who participated in a 10-week IO-GP between January 2019 and June 2022 due to cancer. The IO-GP is offered at the setting of a university hospital and is open to adult patients with cancer. It contains elements from mind-body medicine and positive psychology, as well as recommendations on healthy diet, exercise and CAM approaches. Patients who completed the IO-GP at least 12 months prior (1-4.5 years ago) were included in this study. Statistical analysis included descriptive analysis and parametric and nonparametric tests to identify significant differences (P < .05).

RESULTS

Resilience increased significantly ≥12 months after participation in the IO-GP (n = 44, P = .006, F = 8.274) and had a medium effect size (r = .410). The time since the IO-GP was completed ("12-24 months," "24-36 months," and ">36 months") showed no statistically significant interaction with changes in resilience (P = .226, F = 1.544). The most frequently used CAM modalities within the past 12 months were vitamins/minerals (85.7%), relaxation techniques (54.3%), herbs and plant medicine (41.1%), yoga (41.4%) and meditation (41.4%). The IO-GP was the most common source informing study participants about relaxation techniques (n = 24, 64.9%), meditation (n = 21, 72.4%) and taking vitamin D (n = 16, 40.0%). Significantly greater levels of resilience were found in those practicing meditation (P = .010, d = -.642) or visualization (P = .003, d = -.805) compared to non-practitioners.

CONCLUSION

IO-GPs have the potential to empower patients with cancer to continue using CAM practices-especially from mind-body medicine-even 1 to 4.5 years after completing the program. Additionally, resilience levels increased. These findings provide notable insight into the long-term effects of integrative oncology interventions on resilience and the use of CAM, especially in patients with breast cancer.

Evaluation of a New Integrative Health and Wellness Clinic for Veterans at the San Francisco VA Health Care System: A Mixed-Methods Pilot Study

Objective

The Integrative Health and Wellness Clinic (IHWC), established in 2019 at the San Francisco VA Health Care System, is an interdisciplinary clinic consisting of a medical provider, dietician, physical therapist, and psychologist trained in complementary and integrative health (CIH) following the VA Whole Health model of care. Veterans with complex chronic conditions seeking CIH and nonpharmacologic approaches are referred to the IHWC. This study evaluated the clinic's acceptability and feasibility among veteran patients and its preliminary impact on health and wellbeing, health-related goals, and use of CIH approaches.

Methods

Mixed methods were used to assess patient-reported outcomes and experiences with the IHWC. Participants completed surveys administered at baseline and 6-months and a subset completed a qualitative interview. Pre- and post-scores were compared using t-tests and chi-square tests.

Results

Thirty-five veterans completed baseline and 6-month follow up surveys. Of these, 13% were women; 24% < 50 years of age, and 44% identified as racial/ethnic minorities. Compared to baseline, at 6 months, there were significant (P < .05) improvements in overall health, physical health, perceived stress, and perceived helpfulness of clinicians in assisting with goal attainment; there was a trend toward improved mental health (P = .057). Interviews (n = 25) indicated satisfaction with the interdisciplinary clinical model, support of IHWC providers in goal attainment, and positive impact on physical and mental health. Areas for improvement included logistics related to scheduling of multiple IHWC providers and referrals to other CIH services.

Conclusion

Results revealed significant improvement in important clinical domains and satisfaction with interprofessional IHWC clinic providers, but also opportunities to improve clinic processes and care coordination. An interdisciplinary clinic focused on CIH and Whole Health is a feasible and acceptable model of care for veterans with complex chronic health conditions in the VA healthcare system.

Use of traditional and complementary medicine by ethnic Indian women living with polycystic ovary syndrome: a global survey

BACKGROUND

Traditional, complementary, and integrative medicine (TCIM) is commonly used by those living with Polycystic Ovary Syndrome (PCOS) but little is known about the use of TCIM such as yoga and Ayurveda in ethnic Indian women with PCOS living worldwide. This survey aimed to explore the prevalence and types of TCIM used and in particular the pattern of use of yoga and Ayurveda including reasons for not using and future interest in using them among non-users.

METHOD

An online, international cross-sectional survey was conducted using a pre-designed survey tool. Participants were ethnic Indian women of reproductive age who reported that they were medically diagnosed with PCOS. Descriptive analysis was used to identify the proportion of TCIM users, while a multivariable binary logistic regression was used to analyze their characteristics.

RESULTS

Data from 3130 respondents were analysed. The prevalence of TCIM use was 80% (2515/3130). Yoga and Ayurveda were the most frequently practised TCIM modalities with a prevalence of 57% and 37% respectively. We found a high future interest in using yoga (81%) and Ayurveda (70%) among the non-users. The motivation for most Ayurveda use was a recommendation from family/friends (66%), rather than personal choice (38%) or the internet (19%). Most women used Ayurveda because it has natural ingredients (64%) and it is safe (60%) and cited its use to be safe and somewhat helpful. The majority of women were currently practising yoga (73%) up to four times a week (54%) at home (93%). Yoga was primarily used to improve overall health (67%), manage weight (64%), stress (54%) hormonal imbalance (49%) and emotional well-being (48%). Barriers to practising yoga were common among the current users and non-users and included lack of motivation (59% and 59%), time constraints (48% and 39%), and non-availability of yoga teachers specialised in PCOS (31% and 23%). Most women found yoga to be helpful and preferred individual one-on-one (52%) yoga sessions specifically tailored for PCOS (58%).

CONCLUSION

This is the first international study that discovered the prevalence and pattern of TCIM use among ethnic Indian women with PCOS living worldwide. We support the urgent need for more research, education, and regulation of different TCIM modalities to promote safe and effective practices globally.

The use of traditional, complementary and integrative medicine in Chinese adolescent and young adult patients with cancer: A multicenter cross-sectional study

PURPOSE

Adolescent and young adult (AYA) patients with cancer often experience unique physical and psychosocial complications. They may turn to traditional, complementary and integrative medicines (TCIM) to address these concerns. To examine the pattern of TCIM use among AYA patients with cancer and explored their preferences regarding TCIM education.

METHODS

Between August 2021 and December 2022, 246 patients diagnosed with cancer between 15 and 39 years old were recruited from hospitals in Hong Kong. They completed a structured questionnaire on TCIM use, symptom burden, psychological status and preference on education content. Multivariable logistic regression was used to identify predictors of TCIM use, adjusting for age and sex.

RESULTS

Overall, 60.2% reported TCIM use, most commonly vitamins (24.0%) and Chinese herbal medicine (22.0%). The most common reasons for using TCIM were to improve general health (70.9%) and manage chronic symptoms (33.1%). Among patients on active treatment, TCIM users tend to report higher anxiety symptoms (aOR = 1.13, 95% CI = 1.02-1.27). TCIM users who were post-treatment were more likely to have chronic comorbidities (aOR = 3.54, 95% CI = 1.29-11.5). AYA patients indicated that they would like TCIM information to address specific needs, particularly fatigue (53.7%) and psychological problems (54.1%).

CONCLUSIONS

The use of TCIM is common among AYA patients with cancer, especially among patients with high symptom burdens. A tailored education programme should be provided based on patients' preferences and needs. Healthcare professionals including oncologists and oncology nurses should communicate with AYA patients about TCIM use and address their needs by making evidence-based referrals/recommendations based on treatment status and symptom burden.

Complementary Medicine in Acute Care Hospitals: Questionnaire Survey with Heads of Bavarian Hospitals

INTRODUCTION

The demand for complementary medicine (CM) is well studied in the outpatient sector, but representative data on type and extent of inpatient care using CM are missing. Therefore, our aim was to examine the range of CM treatments offered and the types of indications for using CM in acute care hospitals in the German state of Bavaria.

METHODS

We conducted a cross-sectional questionnaire survey by contacting the medical heads of all 388 Bavarian acute care hospitals between November 2020 and April 2021. The questionnaire included a wide range of CM to assessed availability of CM supply, most frequent indications, and medical specialities. Furthermore, we assessed basic information about the hospital and the participating medical staff.

RESULTS

A total of 101 (26%) hospitals participated in the survey. At least one CM treatment was offered by 92% of the responding hospitals and 75% offered at least 5 therapy modalities (mean of 10 treatments, range: 0-25). These were most commonly massage therapies (68%), relaxation techniques (63%), phytotherapy (60%), mindfulness-based treatments (53%), art, diet, and exercise therapies (each 48%), aromatherapy (46%), acupuncture, and compresses/poultices (both 42%). The most reported medical conditions for CM treatments (in descending order) were chronic pain, mental disorders, degenerative affections, sleep disorders, fatigue syndrome, functional gastrointestinal disorders, and acute pain.

CONCLUSION

According to the Bavarian acute care hospitals that participated in our postal survey, a considerable part offered CM. Further research should include personal interviews and more detailed assessments of indications and attitudes for the use of CM in acute care hospital settings.

Einleitung

Die Nachfrage nach Komplementärmedizinischen Verfahren (CM) ist für den ambulanten Sektor gut untersucht, aber es fehlen Daten über Art und Umfang der komplementärmedizinischen Versorgung im stationären Bereich. Unser Ziel war es daher, das CM-Angebot und die medizinischen Indikationen in Akutkrankenhäusern im Bundesland Bayern zu untersuchen.

Methoden

Wir führten eine Querschnittsbefragung durch, bei der die klinischen Leitungen aller 388 bayerischen Akutkrankenhäuser zwischen November 2020 und April 2021 angeschrieben wurden. Der Fragebogen inkludierte ein breites Spektrum an CM-Verfahren und erfasste deren Verfügbarkeit, die häufigsten Indikationen und Anwendungsgebiete. Ergänzend wurden grundlegende Informationen des Krankenhauses und des medizinischen Personals erfragt.

Ergebnisse

Insgesamt nahmen 101 (26%) Krankenhäuser an der Befragung teil. Die meisten Ausfüllenden hatten mindestens zwei Jahrzehnte klinische Berufserfahrung. Mindestens eine CM Behandlung wurde von 92% der teilnehmenden Krankenhäuser angeboten und 75% boten mindestens 5 Therapiemodalitäten an (Mittelwert: 10 Behandlungen; Spanne: 0–25). Dabei handelte es sich am häufigsten um Massagen (68%), Entspannungstechniken (63%), Phytotherapie (60%), achtsamkeitsbasierte Behandlungen (53%), Kunst-, Ernährungs-und Bewegungstherapie (jeweils 48%), Aromatherapie (46%), Akupunktur und Kompressen/Umschläge (jeweils 42%). Die häufigsten genannten Indikationen für CM-Behandlungen waren (in absteigender Reihenfolge) chronische Schmerzen, psychische Störungen, degenerative Erkrankungen, Schlafstörungen, Erschöpfungssyndrom, funktionelle Magen-Darm-Beschwerden und akute Schmerzen.

Schlussfolgerung

Nach Angaben der bayerischen Akutkrankenhäuser, die an unserer postalischen Umfrage teilgenommen haben, bietet ein erheblicher Teil CM an. Weitere Untersuchungen sollten persönliche Interviews und detailliertere Bewertungen der Indikationen und Einstellungen für den Einsatz von CM in Akutkrankenhäusern umfassen.

Complementary and alternative medicine use by pregnant women in Japan: a pilot survey

BACKGROUND

Complementary and alternative medicine (CAM) are popular among women, and are used during their pregnancy in Japan. This study aimed to survey the prevalence of CAM use by healthy pregnant women as a health-care prescribed therapy or self-care and to investigate the factors associated with CAM use in Japan.

METHODS

In this cross-sectional study, pregnant women after 34 weeks of gestation were asked to respond to a questionnaire at the clinic or online. The questionnaire comprised questions on the participants' characteristics and their use of CAM for therapy and self-care. Descriptive statistics were calculated in the analyses, and bivariate and multivariate logistic analyses were performed to evaluate the associations between factors and CAM use.

RESULTS

A total of 394 women responded from three hospitals, two clinics, and two midwifery birth centers. CAM was received as treatment by practitioners during pregnancy by 75 women (19.0%). The following therapies were used: traditional Chinese medicine (7.9%), chiropractic (6.9%), moxibustion (6.4%), and acupuncture (5.3%). One or more types of therapy were used as self-care by 348 women (88.3%). Highly used CAM for self-care were: folic acid supplementation (75.4%), other supplements (51.5%), herbs (20.8%), and yoga (19.0%). Multiple logistic regression analyses revealed that the factors associated with CAM use as a therapy were midwifery birth centers for planned childbirth settings (adjusted odds ratio [AOR] 3.64, 95% confidence interval [CI] [1.69-7.83]) and pregnancy complications diagnosed (AOR 2.46, 95%CI [1.38-4.39]). The factors associated with CAM use for self-care were age 30-39 years (AOR 4.48, 95%CI [2.14-9.73]) and over 40 years (AOR 3.92, 95%CI [1.10-13.91]), junior college education or above (AOR 2.30, 95%CI [1.18-4.51]), and primiparas (AOR 3.82, 95%CI [1.86-7.86]). The most common source of information was the "Internet" (43.8%).

CONCLUSIONS

Approximately 20% of Japanese pregnant women received CAM as therapy by practitioners, and the related factors were: tended to have baby at midwifery birth center and pregnancy complications. Almost 90% of respondents used CAM as self-care and the related factors were: older, had a higher educational level and tended to be primiparas. They used the Internet as their main source of information about CAM. Health care providers need to provide evidenced-based information on CAM and to help decision making to ensure safe and effective CAM utilization by pregnant women.

Use of complementary and integrative health in Finland: a cross-sectional survey

BACKGROUND

Population based studies have shown large differences in the estimated prevalence of complementary and integrative health (CIH) usage between studies. This is in part due to there being no golden standard definition for CIH. In Finland, an updated and internationally comparable study on the prevalence of CIH usage is needed. In the present study, a modified Finnish version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-QFI) was utilised to examine prevalence of use of different CIH modalities and their experienced helpfulness in the general Finnish population.

METHODS

Respondents aged 16 and above were invited to take part in this descriptive cross-sectional study through an online panel in December 2022. The usage of CIH and the experienced helpfulness were calculated with SPSS (v28) as the proportion of users per each modality. The data were weighted based on gender, age and place of residence.

RESULTS

A total of 3244 respondents completed the survey. CIH was used by 51.1% (95%CI: 49.4-52.8) of the respondents in the 12 months prior to the survey. Self-help practices were the most used category of CIH (28.8%; 95%CI: 27.3-30.4). The prevalence of usage of CIH natural remedies excluding vitamins and minerals was 27.0% (95%CI: 25.5-28.6). CIH providers were visited by 20.4% of the respondents (95%CI: 19.0-21.8). Getting help for a long-term illness or improvement of well-being were often mentioned as the most important reason for the use of different CIH modalities. CIH was generally used more by women compared to men. The large majority found the modalities they used helpful.

CONCLUSIONS

The results increase current understanding on CIH usage in Finland. As the majority of users experience CIH as helpful, there is a need to study CIH in the context of public health policies. The estimates of CIH usage are highly dependent on what is considered as CIH, and this should be paid attention to in future studies.

The Use of Magnets, Magnetic Fields, and Copper Devices in a Veteran Population

Background

Complementary and alternative medicine (CAM) use is increasing in the US and throughout the world. The use of magnets, magnetic fields, and copper devices (MMFC) for health care are CAM therapies. Available information suggests significant consumer spending on MMFC therapy, but minimal information exists on usage patterns.

Methods

We created a brief questionnaire and distributed it to veteran patients at the Carl T. Hayden Veterans Affairs Medical Center infusion center in Phoenix, Arizona. The questionnaire categorized respondents by age groups, diagnostic groups by specialty (endocrinology, gastroenterology, hematology/oncology, neurology, rheumatology, and other), and whether MMFCs were being used and for what purpose. The questionnaire also asked whether the respondent would consider participating in a clinical study using MMFCs.

Results

Analyzing the 206 evaluable surveys, we found an overall use rate of about 1 in 4 respondents. The majority used copper devices, and the endocrinology group showed the highest percentage use. Many veterans reported that they would consider participating in MMFC clinical studies. For interest in clinical trial participation, the age groups with the highest response for magnets in clinical trials was 31 to 50 years (64%), and for magnetic fields 51 to 65 years (52%).

Conclusions

About 25% of surveyed veterans reported the use of MMFCs. Veterans reported that they are likely to participate in clinical studies using these CAM therapies.

Relationship among symptoms, quality of life, and complementary and alternative medicines use among patients undergoing hemodialysis in French-speaking Switzerland

BACKGROUND

Chronic renal disease is considered a main public health problem due to its high prevalence in the population. The solution of choice currently available is kidney transplantation but when this option is not available, blood purification treatments, notably haemodialysis (HD), are necessary. The presence of chronic renal disease combined with this demanding medical procedure leads to a hard symptomatology. To face this situation, HD patients often resort to complementary and alternative medicines (CAM) as they perceive that the healthcare professionals aren't paying enough attention to their quality of life. Given this background, we aim to describe the prevalence and the type of the CAM used among HD patients and their possible relations with patients' symptomatology and quality of life.

METHODS

We interviewed 88 patients, undergoing hemodialysis in three hemodialysis centers in French-speaking Switzerland, about the presence of symptoms, their quality of life, and the possible use of CAM. Cluster analysis was used to create patients' profiles about CAM use and regression analysis to explore the links between symptoms' presence, patients' quality of life, and CAM use.

RESULTS

Our results show a large use of CAM: almost two HD patients out of three uses at least one CAM. Using cluster analysis, we were able to identify five patients' profiles: non-users (37.5% of our sample), users of herbal medicine (20.5%), users of prayer-based practices (18.2%), people mainly using massages (9.1%), and a residual group including the users of other CAMs, with a predominance of meditation (14.8%). As expected, we observe a negative relation between the number of declared symptoms and patients' quality of life. Contrarily, we observe no relation between the use of CAM and the presence of symptoms. Our results show a positive relationship between the use of CAM and patients' overall perception of health as well as the psychological dimension of their quality of life. No relationship is observed with other dimensions of quality of life, notably the physical dimension.

CONCLUSIONS

Our results suggests that CAMs aren't used as a substitute of official medicine but as a parallel support to HD patients' quality of life.

Clinical associations for traditional and complementary medicine use among norwegian cancer survivors in the seventh survey of the Tromsø study: a cross-sectional study

BACKGROUND

Cancer survivors are a diverse group with varying needs that are patient-, disease-, and/or treatment-specific. Cancer survivors have reported supplementing conventional anti-cancer treatment with Traditional and Complementary Medicine (T&CM). Although female cancer survivors are reported to have more severe anticancer adverse effects, little is known about the association between anticancer treatment and T&CM use among Norwegian cancer survivors. The aims of this study are therefore to investigate (1) associations between cancer diagnosis characteristics and T&CM utilization and (2) associations between anticancer treatment and T&CM utilization among cancer survivors in the seventh survey of the Tromsø study.

METHODS

Data was collected from the seventh survey of the Tromsø Study conducted in 2015-16 among all inhabitants of Tromsø municipality aged 40 and above (response rate 65%), where inhabitants received online and paper form questionnaires. Data from the data linkage to the Cancer Registry of Norway for cancer diagnosis characteristics was also used. The final study sample was made up of 1307 participants with a cancer diagnosis. Categorical variables were compared using Pearson's Chi-square test or Fisher's exact test while independent sample t-test was used to compare continuous variables.

RESULTS

The use of T&CM the preceding 12 months was reported by 31.2% of the participants with natural remedies as the most reported modality of T&CM (18.2%, n = 238), followed by self-help practices of meditation, yoga, qigong, or tai chi, which was reported by 8.7% (n = 114). Users of T&CM were significantly younger (p = .001) and more likely to be female (p < .001) than the non-users, with higher use of T&CM among female survivors with poor self-reported health and being 1-5 years post-diagnosis. Lower use of T&CM was found among female survivors who received a combination of surgery with hormone therapy and those who received a combination of surgery with hormone therapy and radiotherapy. Similar usage was seen in male survivors, but not at a significant level. For both male and female survivors, T&CM was most frequently used by those with only one cancer diagnosis (p = .046).

CONCLUSION

Our results indicate that the profile of the Norwegian cancer survivor who uses T&M is slightly changing compared to previous findings. Additionally, compared to male survivors, more clinical factors are associated with use of T&CM among female cancer survivors. These results should serve as a reminder to conventional health care providers to discuss the use of T&CM with patients across the entire cancer survivorship continuum to promote safe use, especially among female survivors.

Utilization of complementary and alternative medicine by perimenopausal women in China: a cross-sectional study

OBJECTIVE

To investigate the utilization of complementary and alternative medicine (CAM) by perimenopausal women and explore factors associated with their preference.

METHODS

A cross-sectional study was conducted involving 558 perimenopausal women in Wuhan, China. Online questionnaires were available from December 2021 to April 2022. Instruments used were the International Complementary and Alternative Medicine Questionnaire and the Greene Climacteric Scale. The association between scores and participants' sociodemographic characteristics and perimenopausal symptoms was analyzed using multiple linear regression.

RESULTS

The overall utilization of CAM by perimenopausal women was 50.4% (281/558). Perimenopausal symptoms affecting the frequency of CAM usage included anxiety (adjusted β = 0.18), somatic (adjusted β = 0.07), and vasomotor symptoms (adjusted β = 0.76), P < 0.05. The most commonly used CAM were massage (37.7%), herbal therapies (19.9%), and dietary supplements (18.2%). Walking (58.6%) was the most popular self-practice therapy. Perimenopausal women consulted Western (38.4%) and Chinese medicine physicians (34.8%) and dentists (36.0%) most frequently.

CONCLUSIONS

Perimenopausal women experience discomforts during this age-related stage, and their use of CAM to manage symptoms is common. The usage and preferences of these management strategies are worthy of further exploration. There is a need to understand cost-effective and appropriate management interventions to improve the quality of life of perimenopausal women.

A Qualitative Study Among Healthcare Providers on Risks Associated With the Use of Supportive Care for Cancer Treatment-Related Symptoms in Children and Adolescents

INTRODUCTION

Although more than 300 000 children and adolescents worldwide are diagnosed with cancer yearly, little research has been conducted investigating how healthcare providers consider risk and patient safety connected with supportive care (including complementary and alternative medicine [CAM]) in this age group. This study aimed to explore how different healthcare providers perceive and evaluate risk when patients combine supportive care and conventional medicine in clinical practice and how they communicate and inform parents about the use of these modalities.

MATERIALS AND METHODS

In-depth semi-structured interviews were conducted with 22 healthcare providers with expertise in treating pediatric oncology patients from 5 countries. Systematic content analysis was conducted using Nvivo 1.61.

RESULTS

The analysis resulted in 3 themes and 8 subthemes. Generally, participants were cautious about implementing unproven new modalities or therapies when recommending supporting care modalities to parents of children and adolescents with cancer. The most important criterion when recommending a modality was evidence for safety based on a risk/benefit evaluation. Negative interactions with conventional medicine were avoided by using the half-life of a drug approach (the time it takes for the amount of a drug's active substance in the body to reduce by half). For patients with severe symptoms, less invasive modalities were used (ear seeds instead of ear needling). To enhance safety, participants practiced open and egalitarian communication with parents.

CONCLUSION

Healthcare providers reported using a variety of approaches to achieve a safe practice when parents wanted to combine supportive care and conventional cancer treatment. They emphasized that these modalities should be foremost safe and not become an extra burden for the patients. Providers highlighted patient-centered care to meet the individual's specific health needs and desired health outcomes. A lack of national and regional standardized training programs for supportive care in pediatric oncology was considered a hazard to patient safety.

Translation and Cross-Cultural Adaptation of the International Questionnaire to Measure the Use of Complementary and Alternative Medicine (I-CAM-Q) for the Polish and Cross-Sectional Study

According to the World Health Organization (WHO), complementary and alternative medicine (CAM) encompasses a broad set of health care practices that are not part of a country's traditional or conventional medicine and are not fully integrated into the prevailing health care system. The aim of this study is the linguistic and cross-cultural adaptation of the Polish version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q) and the assessment of the occurrence and factors related to CAM among patients in Poland. A methodological model of translation and cross-cultural adaptation of research tools according to Beaton et al. with a Delphi-Technique was used for the linguistic and cultural adaptation of the Polish version of I-CAM-Q. The Delphi consensus was achieved in the scale assessment between the experts in two rounds (with a score of above 80% of expert agreement). Data was collected using an online survey within 38 thematically different groups on Facebook, among 524 participants. Over half (59.7%, n = 313) of the respondents used the services of at least one CAM practitioner. On the other hand, 50.8% (n = 266) of the respondents declared using physician's advice. The use of herbs and plant products was reported by 84.7% (n = 444), and vitamins and minerals by 88.4% (n = 463) of respondents. The most commonly used self-help practices among the respondents were relaxation techniques (49.6%), praying for one's health (43.3%) and meditation (41.2%). The consensual methodology of validating the Polish version of the I-CAM-Q scale allowed for creation of a conceptually and linguistically equivalent tool with the original international instrument. A high frequency of CAM use was found among the respondents. Therefore, strategies should be implemented to improve patient-physician communication on the use of CAM in Poland.

Prevalence of late and long-term effects of cancer (treatment) and use of complementary and alternative medicine in Norway

BACKGROUND

The increasing number of patients surviving cancer leads to more people experiencing late and long term-effects from the disease and its treatment. Fatigue, sleep disorders, early menopause, pain, and nerve damage are commonly reported. Methods helping people to recover after cancer treatment are therefore essential. The aims of this study were threefold; (1) to determine the level of cancer patients suffering from late and long-term effects of cancer diagnosis and treatment in Norway, (2) explore complementary and alternative medicine (CAM) modalities used for managing these adversities, and (3) describe self-perceived benefits and harms of the CAM interventions.

METHODS

The study was conducted in cooperation with the Norwegian Cancer Society (NCS) and consisted of an online cross-sectional study among members of the NCS user panel with present or previous cancer (n = 706). The study was carried out in September/October 2021 using a modified cancer-specific version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). A total of 315 women and 153 men agreed to participate, resulting in a response rate of 67%.

RESULTS

Most of the participants (83%) suffered from late and long-term effects of cancer treatment; mostly fatigue (59.2%), sleep disorder (41.5%), hot flashes (39.2%), nerve damage (polyneuropathy, 38.0%), and pain (36.6%) with a mean number of 5.1 different late and long-term effects. Late and long-term effects were positively associated with younger age and college/university education. Nearly half of the participants experiencing late and long-term effects (43%) reported having used CAM to treat these complaints. Most frequently used were self-help practices (26%) such as relaxation therapy (19%), yoga (14%) and meditation (13%), but also visits to CAM providers were reported by 22%. Herbal- and other natural remedies to treat late and long-term effects were used by 13%. A high percentage of CAM users reported self-perceived improvements of their symptoms (86% for self-help practices, 90% for visits to CAM providers). Few experienced adverse effects of the CAM treatment.

CONCLUSION

A large proportion of cancer patients suffered from a wide range of late and long-term effects of cancer diagnosis and treatment, and they use CAM to treat these complaints to a rather high degree. Relaxation therapy, yoga, meditation, massage, and acupuncture were the most frequently used therapies regardless of complaint. The therapies used are generally considered to be both safe and beneficial for the respective complaint, indicating that the participants seem to be well informed about the choices they make.

Complementary and alternative medicines chosen for specific health problems: Internet survey using the I-CAM-Q in Japan: A STROBE-compliant cross-sectional study

This study investigated the different complementary and alternative medicines (CAMs) adopted by people in Japan, as well as the health problems treated with CAMs. Understanding more about this topic will facilitate the appropriate incorporation of CAMs into conventional medicine when treating health problems. Data were collected through an online survey based on the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). The study examined CAM utilization among people aged 20 years or older; 164 valid responses were collected (18.9%). We adopted a cross-sectional design. We then compared the relationships between the specific health problems reported by participants, their self-help practices, and the kinds of healthcare specialists consulted. We also examined participants' reasons for using CAMs and their responses regarding the usefulness of the CAMs adopted. We found that self-help/CAM practices differed for specific health problems. Participants with musculoskeletal and heart problems were more likely to use poultices. Those with respiratory and digestive problems were more likely to practice yoga, tai chi, and qigong. Those with digestive and neurological problems were more likely to use aromatherapy. The I-CAM-Q questionnaire also revealed the purpose and usefulness of the CAMs utilized as well as the participants' attitudes regarding conventional medicine. The study showed that participants find physicians less helpful than other options for treating their health problems. Additionally, when asked whether it was helpful to consult with a specific professional for health problems, there was a higher percentage of participants who answered "Very helpful" for professionals, like massage, judo, acupuncture, and moxibustion therapists, than for physicians. The results of this study will help to inform medical providers of the most appropriate types of CAMs for dealing with various health problems.

Prevalence, determinants and outcomes of traditional, complementary and alternative medicine use for hypertension among low-income households in Malaysia and the Philippines

BACKGROUND

Traditional, complementary and alternative medicine (TCAM) is used to treat a broad range of conditions. In low- and middle-income countries (LMICs), TCAM use is particularly common among those with low socio-economic status. To better understand the patterns and impact of TCAM use on the management of non-communicable diseases in these populations, this study examines the prevalence and characteristics of TCAM use for hypertension, its determinants, and its association with hypertension management outcomes and wellbeing among low-income adults in two Southeast Asian countries at different levels of economic and health system development, Malaysia and the Philippines.

METHODS

We analysed cross-sectional data from 946 randomly selected adults diagnosed with hypertension from low-income rural and urban communities in Malaysia (n = 495) and the Philippines (n = 451). We compared the prevalence, characteristics and household expenditure on TCAM use between countries and used multi-level, mixed-effects regression to estimate associations between TCAM use and its determinants, and five hypertension management outcomes and wellbeing.

RESULTS

The prevalence of TCAM use to manage hypertension was higher in the Philippines than in Malaysia (18.8% vs 8.8%, p < 0.001). Biologically-based modalities, e.g. herbal remedies, were the most common type of TCAM used in both countries, mainly as a complement, rather than an alternative to conventional treatment. Households allocated around 10% of health spending to TCAM in both countries. Belief that TCAM is effective for hypertension was a positive predictor of TCAM use, while belief in conventional medicine was a negative predictor. TCAM use was not strongly associated with current use of medications for hypertension, self-reported medication adherence, blood pressure level and control, or wellbeing in either country.

CONCLUSIONS

A small, but significant, proportion of individuals living in low-income communities in Malaysia and the Philippines use TCAM to manage their hypertension, despite a general lack of evidence on efficacy and safety of commonly used TCAM modalities. Recognising that their patients may be using TCAM to manage hypertension will enable health care providers to deliver safer, more patient-centred care.

Health-seeking behaviour, referral patterns and associated factors among patients with autoimmune rheumatic diseases in Ghana: A cross-sectional mixed method study

Background

Challenges exist in the diagnosis and management of autoimmune rheumatic diseases in low and middle income countries due to factors, such as poverty and under-resourced healthcare infrastructure. Furthermore, other contributory factors such as societal, cultural and religious practices influence health seeking behaviour which has a bearing on access and delivery of healthcare.

Objectives

To examine the health seeking behaviour and referral patterns of Ghanaian patients with autoimmune rheumatic diseases and assess the associated factors that influence these.

Method

A cross-sectional study using an explanatory sequential mixed method design was carried out in a Rheumatology clinic at a national referral centre. 110 participants were purposively recruited for the quantitative phase. The qualitative phase comprised 10 participants for in-depth interviews and 10 participants for a focus group discussion. Analysis using descriptive statistics, t-tests and logistic regression models were performed. Transcripts generated from the interviews and focused group discussion were analysed using thematic analysis.

Results

Median duration from onset of symptoms until seeking help was 1 week (IQR = 12); from seeking help until obtaining a final diagnosis was 12 months (IQR = 33). Multiple factors determined the choice of first facility visited, X² (12, N = 107) = 32.29, p = .001. Only twenty-one participants (19.6%) had knowledge of their disease prior to diagnosis. Education predicted prior knowledge [OR = 2.6 (95% CI = .66–10.12), p < .021]. Unemployed participants had increased odds of seeking help after a month compared to those who were employed [Odds ratio = 2.60 (95% CI = 1.14–5.90), p = .02]. Knowledge of autoimmune rheumatic diseases was low with multiple causative factors such as biomedical, environmental and spiritual causes determining where patients accessed care. Forty (36.4%) participants utilised complementary and alternative treatment options.

Conclusion

We observed that knowledge about autoimmune rheumatic diseases among Ghanaian patients was low. Patients sought help from numerous medical facilities, traditional healers and prayer camps often contributing to a delay in diagnosis for most patients. This was influenced by individual perceptions, cultural beliefs and socioeconomic status. Active awareness and educational programmes for the public and healthcare workers are required, as well as strategic planning to integrate the biomedical and traditional care services to enable earlier presentation, accurate diagnosis and better clinical outcomes for the patients.

Safety and use of complementary and alternative medicine in Norway during the first wave of the COVID-19 pandemic using an adapted version of the I-CAM-Q; a cross-sectional survey

BACKGROUND

The COVID-19 pandemic lockdown has had a profound impact on physical and mental well-being throughout the world. Previous studies have revealed that complementary and alternative medicine (CAM) is frequently used for, and can be potential beneficial for strengthening physical mental resilience. The aims of this study were therefore to determine the prevalence and reasons for use of CAM during the first wave of the COVID-19 pandemic among a representative sample of the Norwegian population, and further determine self-reported effects and adverse effects of the CAM modalities used.

METHODS

Computer assisted telephone interviews using a COVID-adapted I-CAM-Q questionnaire were conducted with 1008 randomly selected Norwegians aged 16 and above using multistage sampling during April and May 2020 applying age and sex quotas for each area. Frequencies, Pearson's chi-square tests, Fisher exact tests, and independent sample t-test were used to identify the users of CAM, what they used, why they used it and whether they experienced effect and/or adverse effects of the modalities used, and further to describe differences in sociodemographic factors associated with CAM use. Cronbach's alpha tests were used to test for internal consistency in the different groups of CAM. Significance level was set to p < 0.05.

RESULTS

The study revealed that two thirds of the respondents (67%) had used CAM within the first 3 months of the COVID-19 pandemic, in particular CAM modalities that did not involve a provider. Most used were natural remedies and dietary supplement (57%, mainly vitamins and minerals), but self-help practices like yoga and meditation were also widely used (24%). Women used CAM modalities significantly more than men (77% vs. 58%). Most of the respondents found the modalities they used beneficial, and few reported adverse effects of the treatments.

CONCLUSIONS

A large proportion of the Norwegian population used CAM during the first wave of the COVID-19 pandemic with high satisfaction and few reported adverse effects. CAM was rarely used to prevent or treat COVID-19, but rather to treat a long-term health condition, and to improve well-being.

Prevalence of complementary and alternative medicine use in Brazil: results of the National Health Survey, 2019

BACKGROUND

In recent decades, it has been possible to observe an increase in Complementary and Alternative Medicine (CAM) usage globally for both disease prevention and health promotion purposes. we aim to estimate the prevalence of CAM use and analyze associated factors in Brazil.

METHODS

Observational study with data from the 2019 National Health Survey that evaluated a sample of Brazilian adults. The outcome was CAM use, such as acupuncture, homeopathy, medicinal plants and herbal medicines, meditation, and yoga in the last 12 months. A logistic regression model with a 99% confidence interval was used to assess factors associated with CAM use.

RESULTS

The prevalence of CAM use in 2019 was 5.2% (CI99% = 4.8-5.6%), the most used modalities: medicinal plants and herbal medicines, with a prevalence of 3.0% (CI99% = 2.7-3.33) followed by: acupuncture 1.4% (CI99% = 1.3-1.6) homeopathy 0.9% (CI99% = 0.7-1.0), meditation 0.7% (CI99% = 0.6-0.8) and yoga 0.4% (CI99% = 0.4-0.5). We observed important geographical differences in CAM use in Brazil, with a higher prevalence in the North Region, 3.7% (CI99% = 2.81-4.75), where herbal medicines were more frequent the in the other regions. After estimating an adjusted model, women, older people, and people with a higher level of education and per capita income were the ones who used all types of CAM the most. The practice of yoga stands out among women 3.6% (CI99% = 2.49-5.28) and among individuals with higher per capita income 7.5% (CI99% = 2.97-18.93); meditation among individuals with higher educational level 13.4% (CI99% = 6.41-28.33) and acupuncture for those who declared regular or poor health 1.9% (CI99% = 1.51-2.39).

CONCLUSIONS

We recommend that the Ministry of Health expand CAM access to Unified Health System users and promote health professionals' conscious and guided use for the Brazilian population.

Use of Complementary and Alternative Medicine in the context of cancer; prevalence, reasons for use, disclosure, information received, risks and benefits reported by people with cancer in Norway

BACKGROUND

Research exploring the use of specific Complementary and Alternative Medicine (CAM) modalities by Norwegian cancer patients is sparse. The aims of this study were therefor to map the different CAM modalities cancer patients use and further investigate their rationale for use, communication about use, self-reported benefits and harms, and their sources of information about the different modalities.

METHODS

In cooperation with the Norwegian Cancer Society (NCS), we conducted an online cross-sectional study among members of their user panel with present or previously cancer (n = 706). The study was carried out in September/October 2021 using a modified cancer-specific version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). In total, 468 members, 315 women and 153 men, agreed to participate resulting in a response rate of 67.2%. The study was reported in accordance with the National Research Center in Complementary and Alternative Medicine's (NAFKAM) model of reporting CAM use.

RESULTS

A large proportion of the participants (79%, n = 346) had used some form of CAM with a mean of 3.8 modalities each (range 1-17); 33% (n = 143) had seen a CAM provider, 52% (n = 230) had used natural remedies, while 58% (n = 253) had used self-help practices. Most of the participants used CAM to increase their quality of life, cope with the cancer disease or for relaxation/well-being (64%-94%), mostly with high satisfaction and low rates of adverse effects. Few used CAM to treat cancer or prevent it from spreading (16%, n = 55). The main information sources were health care providers (47%), the internet (47%), and family and friends (39%). More than half (59%) of the cancer patients discussed their use of at least one CAM modality with a physician.

CONCLUSIONS

The results of this survey will provide health professionals with more in-depth insight into the patterns of CAM use by cancer patients and facilitate better-informed discussions with their patients. Considering the high use of CAM, reliable information provision supporting cancer care providers' knowledge and health literacy among patients as well as good communication are crucial. The cooperation between the NCS and NAFKAM provides an example of how to address these issues.

Prevalence of Use of Traditional, Complementary and Alternative Medicine by the General Population: A Systematic Review of National Studies Published from 2010 to 2019

INTRODUCTION

Traditional, complementary and alternative medicine (TCAM) refers to a broad range of health practices and products typically not part of the 'conventional medicine' system, and its use is substantial among the general population. TCAM products and therapies may be used in addition to, or instead of, conventional medicine approaches, and some have been associated with adverse reactions or other harms.

OBJECTIVES

The aims of this systematic review were to identify and examine recently published national studies globally on the prevalence of TCAM use in the general population, to review the research methods used in these studies and to propose best practices for future studies exploring prevalence of use of TCAM.

METHODS

MEDLINE, Embase, CINAHL, PsycINFO and AMED were searched to identify relevant studies published since 2010. Articles/reports describing the prevalence of TCAM use in a national study among the general population were included. The quality of included studies was assessed using a risk of bias tool developed by Hoy et al. Relevant data were extracted and summarised.

RESULTS

Forty studies from 14 countries, comprising 21 national surveys and one cross-national survey, were included. Studies explored the use of TCAM products (e.g. herbal medicines), TCAM practitioners/therapies, or both. Included studies used different TCAM definitions, prevalence time frames and data collection tools, methods and analyses, thereby limiting comparability across studies. The reported prevalence of use of TCAM (products and/or practitioners/therapies) over the previous 12 months was 24-71.3%.

CONCLUSION

The reported prevalence of use of TCAM (products and/or practitioners/therapies) is high, but may underestimate use. Published prevalence data varied considerably, at least in part because studies utilise different data collection tools, methods and operational definitions, limiting cross-study comparisons and study reproducibility. For best practice, comprehensive, detailed data on TCAM exposures are needed, and studies should report an operational definition (including the context of TCAM use, products/practices/therapies included and excluded), publish survey questions and describe the data-coding criteria and analysis approach used.

Prevalence of traditional, complementary, and alternative medicine (TCAM) among adult cancer patients in Malawi

PURPOSE

The objective of this study is to document the prevalence of traditional, complementary, and alternative medicine (TCAM) use by adult cancer patients at a national teaching hospital in Malawi. We aim to document the products/therapies used, the reason for use, as well as patient-reported satisfaction with TCAM practitioners and modalities.

METHODS

We conducted investigator-administered interviews with adult cancer patients presenting to the Kamuzu Central Hospital (KCH) Cancer Clinic in Lilongwe, Malawi between January and July 2018. The KCH is a national teaching hospital in the capital of Lilongwe, which serves patients with cancer from the northern half of Malawi. Descriptive statistics were used to describe TCAM use and logistic regression was applied to identify predictors of TCAM.

RESULTS

A total of 263 participants completed the survey, of which 70% (n = 183) were female and average age was 45 (SD 14) years old. The prevalence of overall TCAM use was 84% (n = 222), and 60% (n = 157) of participants reported combining TCAM with conventional cancer treatment. The majority of patients used TCAM to directly treat their cancer versus for symptom management. Patients reported using faith-based healing (64%, n = 168), herbal medicine (56%, n = 148), diet change (46%, n = 120), and vitamins/minerals (23%, n = 61). Participants reported the highest satisfaction for physicians among practitioners and diet change for modalities. Female gender was found to be a predictor of TCAM with conventional treatment use, no other significant predictors were observed.

CONCLUSION

There is a high prevalence of TCAM use among an adult population with cancer in Malawi, and a wide variety in the TCAM modalities used among patients. Additional studies are needed to identify risks and benefits of TCAM use to assist with policy and public health, patient safety, and holistically address the global burden of cancer.

The prevalence of using complementary and alternative medicine products among patients with pressure ulcer

Background

The use of complementary and alternative medicine (CAM) therapies has increased in recent years throughout the world and in Iran. Nonetheless, there are limited data about the prevalence of their use. This study aimed to assess the prevalence of using CAM therapies among patients with pressure ulcer (PU).

Methods

This cross-sectional study was conducted in 2019–2020. Participants were 299 patients with PU conveniently selected from wound clinics and healthcare settings in Shiraz, Iran. A demographic questionnaire and the International Questionnaire to Measure Use of CAM were used for data collection. The data were analyzed using the SPSS software (v. 22.0).

Results

All 299 participants completed the study. Their mean age was 59.56 ± 18.76 years. The most common CAM therapies used for PU management were herbal products (100%), vitamin supplementation therapy (45.2%), spiritual therapies (21.7%), wet cupping therapy (16.4%), leech therapy (9.4%), acupuncture (1.7%), dry cupping therapy (1.3%), and massage therapy (1.3%). The most common herbal product used for PU management was Pistacia atlantica gum either alone or in combination with other herbal products (15.5%). The use of CAM therapies had significant relationship with participants’ age, underlying conditions, and PU stage (P < 0.05) and the most significant predictor of using herbal products for PU was educational level (P < 0.05, OR = 5.098).

Conclusions

The use of CAM therapies, particularly herbal products, for PU management is high in Iran. Quality public education and close professional supervision are needed for the safe use of these products.

Consultations with health care providers and use of self-management strategies for prevention and treatment of COVID-19 related symptoms. A population based cross-sectional study in Norway, Sweden and the Netherlands

OBJECTIVES

The present study was initiated to determine consultations with health care providers and use of self-management strategies for prevention or treatment of COVID-19 related symptoms in countries with a full lockdown (Norway), a partial lockdown (the Netherlands) and no lockdown (Sweden) during the first three months of the COVID-19 pandemic, and if such use correlates with worries of being infected by COVID-19 disease.

DESIGN

Data were collected in collaboration with Ipsos A/S in April-June 2020. An adapted version of the International Questionnaire to measure use of Complementary and Alternative Medicine (I-CAM-Q) was used with the categories "for prevention of COVID-19" and "to treat COVID-19-related symptoms" added. Data were collected among a representative sample in Norway, Sweden and the Netherlands using data assisted telephone interviews (Norway, n=990 and Sweden, n=500), and an online survey (the Netherlands, n=1004). Total response rate was 30%.

RESULTS

Very few consulted a health care provider with the intention to treat or prevent COVID-19 (1.2% and 1.0% respectively) with medical doctors mostly visited (1.0% and 0.9% respectively). Similarly, the use of self-management strategies to prevent or treat COVID-19 was low (3.4% and 0.2% respectively); most commonly used for prevention of COVID-19 were vitamins and minerals (2.8%). Consultations with health care providers and use of self-management strategies for prevention of COVID-19 were positively associated with worries of being infected with COVID-19.

CONCLUSIONS

The COVID-19 pandemic does not seem to have evoked a large-scale difference in behavior related to consultations with health care providers or the use of self-management strategies in any of the three countries.

Medication Adherence, Complementary Medicine Usage and Progression of Diabetic Chronic Kidney Disease in Thais

PURPOSE

Non-adherence to medication is receiving more attention as a significant problem common to management of chronic diseases including diabetes and chronic kidney disease (CKD). This study was designed to assess the medication adherence and self-medication in a cohort of Thai patients with diabetic kidney disease, and its association with clinical outcomes.

PATIENTS AND METHODS

Non-dialysis patients with diabetic CKD visiting outpatient's clinics of Siriraj Hospital, the largest tertiary care in Thailand, were asked for participation. Self-administered questionnaire was given to assess medication adherence (the 6-item-medication-taking-behavior measure in Thai), complementary medicine usage, and personal information. Clinical, pharmaceutical, and relevant laboratory data (at current and the last visit of around 12 months) were abstracted from the medical records.

RESULTS

Of the 220 participants eligible (54.1% male, mean age 71.3), 50.9%, 24.1%, and 25% were classified as high-, medium-, and low-medication adherence, respectively. Overall, 24.1% reported self-usage of at least one type of herbal or complementary medicines. The most commonly identified items were cordyceps, cod liver oil, Nan Fui Chao, and turmeric (6 each), with unidentified Thai herbal mixture in 11. On multivariate analysis, late-stage CKD (stage IV-V) was the only independent predictor for low adherence (odds ratio (OR), 5.54; 95% confidence interval (CI), 2.82-10.88). Low adherence was associated with higher blood pressure, lower estimated glomerular filtrate rate (eGFR), and more eGFR decline with greater risk of being rapid CKD progressor (annual eGFR drop >5 mL/min/1.73 m2) [OR, 1.15; 95% CI, 1.06-1.25].

CONCLUSION

Medication taking behavior was a frequently encountered problem in Thai diabetic CKD patients. Increased medication non-adherence was independently predicted by stages of increasing CKD severity, and it was associated with poorer hypertensive control and kidney outcome. Targeting interventions to improve medication adherence should be an important strategy to slow CKD progression among patients with diabetic CKD.

Prevalence and predictive factors of complementary medicine use during the first wave of the COVID-19 pandemic of 2020 in the Netherlands

Introduction

Major life changing events such as the COVID-19 pandemic may have major impact on one’s health and general well-being. This study aimed to determine the prevalence and predictive factors, including gender specific differences, of Complementary Medicine (CM) use (including CM consultations, self-care management and self-help techniques) during the first wave of the COVID-19 pandemic in 2020 in the Netherlands.

Methods

CM use was studied among a random representative sample (n = 1004) of the adult Dutch population using an online survey conducted from 22–27 May 2020. The survey included a modified version of I-CAM-Q and additional questions on demographic characteristics, reasons for CM use, perceived effectiveness and side effects.

Results

68.0% of the participants reported to have used CM (CM consultations (13.3%), self-management strategies (59.4%), self-help techniques (30.0%)). Most frequently reported reason of CM use was to improve general well-being (61.6%), prevention and/or treatment of COVID-19 was only reported by 10%. Perceived effectiveness of CM was high and number of experienced side effects low. Being a women, worried to get infected with COVID-19, higher education and living in northern/ middle region of the Netherlands were predictive factors to use CM.

Conclusions

In the Netherlands, specific groups (e.g. women/ highly educated) use CM, mainly to improve general wellbeing, and seem to benefit of it during the first months of the pandemic. The high perceived effectiveness and low reporting of side effects should encourage medical professionals and policy makers for more openness towards considering CM as being part of an integrative approach to public health in times life changing events occur.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-022-03528-x.

Conventional health care service utilization among cancer survivors that visit traditional and complementary providers in the Tromsø study: a cross-sectional study

Background

Traditional and complementary medicine (T&CM) is commonly used among cancer patients worldwide. Cancer patients in Norway mainly visit T&CM providers in addition to conventional health care services. It is not known how their utilization of T&CM providers influences their use of conventional health care services. The aim of this study was to investigate the difference between the utilization of conventional health care services among cancer survivors that visit T&CM providers and those that do not, and their associated factors.

Method

Health care service utilization data were obtained from cancer survivors 40 years and above participating in the Tromsø Study: Tromsø 7 conducted in 2015–2016. Data were collected from self-administered questionnaires. Pearson chi-square tests, Fisher exact tests, t-test, and logistic regression were used, with the significance level considered at p < 0.05.

Results

Of 1553 individuals, 10% (n = 155) reported visiting T&CM providers in the past 12 months. As both cancer survivors visiting and not visiting T&CM providers were frequent users of conventional health care, no significant differences were found in the overall use of conventional health care (98.1vs.94.5%, p = .056). Users of T&CM providers were however more likely to visit physiotherapists (40.1% vs 25%, p < .001), emergency rooms (29.2% vs 16.5%, p < .001), chiropractors (17% vs 6%, p < .001), and psychologist/psychiatrist (8.9% vs 3.4%, p < .001). They also had more frequent visits to conventional health care (11.45 vs 8.31 yearly visits, p = 0.014), particularly to general practitioners (5.21 visits vs. 3.94 visits, p = .002).

Conclusion

Results from this study show that visits to T&CM providers are associated with more visits to conventional health care services among cancer survivors. Further studies are needed to investigate the reasons for this high use behavior.