Ancillary use of folk medicine by patients in primary care clinics in southwestern West Virginia

Integrating traditional medical practice with primary healthcare system in Eritrea

BACKGROUND

The purpose of this paper was to assess the perceptions and attitudes of modern medical practitioners (MMPs) and traditional medical practitioners (TMPs) about traditional medical practice and to analyze the utilization of traditional medicine in Eritrea.

METHODS

The data for this study were collected in a 10-month period from January to October 2004. A cross-sectional study was conducted in three sub-zones of Eritrea: Dekemhare, Ghinda, and Maekel. A total of 500 (250 each) MMPs and TMPs, and 1657 households were included in the study. Data were collected both by questionnaire and an interview (with key informants).

RESULTS

Our study reveals that there is a significant difference in perception and attitude between MMPs and TMPs about traditional medical practice in Eritrea. Their differences lie not only in their way of thinking but also in their perceptions of man and health. Our study further shows that in most rural communities in Eritrea, the use of traditional medicine and self-care is extensive. This is the case even in the presence of the supposedly free/subsidized health care available in government health centers.

CONCLUSIONS

Higher confidence in traditional medicine for the treatment of serious illnesses, irrespective of availability of western medical service in many parts of Eritrea, indicates the need for selective integration of traditional medical practice with the primary healthcare system of the country.

Wound care with traditional, complementary and alternative medicine

Wound care is constantly evolving with the advances in medicine. Search for the ideal dressing material still continues as wound care professionals are faced with several challenges. Due to the emergence of multi-resistant organisms and a decrease in newer antibiotics, wound care professionals have revisited the ancient healing methods by using traditional and alternative medicine in wound management. People's perception towards traditional medicine has also changed and is very encouraging. The concept of moist wound healing has been well accepted and traditional medicine has also incorporated this method to fasten the healing process. Several studies using herbal and traditional medicine from different continents have been documented in wound care management. Honey has been used extensively in wound care practice with excellent results. Recent scientific evidences and clinical trials conducted using traditional and alternative medicine in wound therapy holds good promise in the future.

Restoration of renal hemodynamics and functions during black cumin (Nigella sativa) administration in streptozotocin-induced diabetic rats

BACKGROUND

Black cumin (Nigella sativa) is an ancient herbal medicine recommended by the World Health Organization. The antioxidant and antihyperglycemic effects of black cumin are well established. Amelioration of renal dysfunction in nephrotoxic rats with black cumin treatment has also been noted. However, the effect of black cumin treatment on renal dysfunction in diabetes mellitus has not been clarified. In this study, the effect of black cumin oil (BC) on changes in renal dysfunction and renal hemodynamics in streptozotocin-induced diabetic rats was evaluated.

METHODS

The experiments were performed in male Sprague Dawley rats, divided into four groups (seven in each group): (1) normal rats given tap water (CON); (2) normal rats administered with BC (CON-BC); (3) diabetic rats given tap water only (STZ); and (4) diabetic rats administered with BC (STZ-BC). Diabetes mellitus was induced in the rats by an injection of streptozotocin. BC was given orally at the dose of 1000 mg/kg body weight to the rat in either CON-BC or STZ-BC every day for 8 weeks. Renal hemodynamics and functions in each rat were studied.

RESULTS

Renal hemodynamic changes in STZ-BC rats appeared to increase in terms of glomerular filtration rate, effective renal plasma flow, and effective renal blood flow, while renal vascular resistance and filtration fraction were decreased in comparison with diabetic rats given tap water only (STZ). An improvement of renal tubular dysfunction in STZ-BC rats was indicated by the decreases in fractional excretion of water and Mg(++).

CONCLUSION

An administration of BC can restore changes in renal hemodynamics and renal dysfunction in streptozotocin-induced diabetic rats.

Senior and Health-Professionals' Perceptions and Communication about Prescriptions and Alternative Therapies

Les patients et les professionnels éprouvent de la difficulté à communiquer entre eux en ce qui concerne les ordonnances et les médecines parallèles. Cette recherche visait à étudier et à rapprocher les perceptions et les échanges de 714 aîné(e)s et professionnels de la santé sur ces produits de santé. D'abord, on a effectué des entretiens personnels et ethnographiques avec des professionnels de la santé et des aîné(e)s pour déceler les questions de préoccupation pertinentes. Ensuite, on a utilisé des groupes de discussion pour évaluer les questions et la formulation des éléments initialement développées. Troisièmement, une étude a permis d'établir des associations et la validité prédictive des variables des deux premières étapes. Parmi les grandes lignes des thèmes, on note des perceptions différentes sur (a) la valeur et l'utilisation des médecines parallèles, (b) la précision de l'information sur les ordonnances et les médecines parallèles et (c) la communication sur la mauvaise utilisation des ordonnances et l'utilisation des médecines parallèles. Les aîné(e)set les professionnels ont présenté des recommandations d'amélioration de la pratique clinique.

Rationales for CAM Education in Health Professions Training Programs

The authors review the use of complementary and alternative medicine (CAM) in the United States. They then present and discuss the rationales used by the 15 National Center for Complementary and Alternative Medicine CAM educational grantees in their original proposals for incorporating CAM content into conventional health professions training programs. Fourteen of the grantees were from major U.S. medical and nursing schools, and one was from a medical student foundation. Awards were for five-year periods (with the exception of one three-year grant) from 2000 to 2008. Rationales for developing educational programs about CAM for conventional health professionals included (1) the prevalence and growth of CAM in the United States, (2) response to governmental, legislative, and other mandates, (3) need for enhanced communication between conventional providers and patients using CAM, (4) need to enhance safety of CAM use and interactions with conventional care, (5) CAM education's positive impact on broadening core competencies for conventional health care professionals, (6) positive impact on enhancing cultural competency, (7) need for better communication between conventional and CAM providers, (8) potential for improving health care coordination, (9) potential impact on increasing CAM research quality and capacity, and (10) potential for enhancing quality of care through informed CAM use. Integration of CAM with conventional health care requires educational venues that prepare conventionally trained caregivers with a sufficient knowledge base for assessing beneficial and detrimental interactions between CAM and conventional care approaches; development of criteria for making informed referrals to CAM practitioners; and enhanced research capacity.

Complementary Therapy and Older Rural Women

BACKGROUND

Despite the growing use of complementary therapy by consumers in the United States, very little is known about the factors associated with the use of these therapies among older rural women.

OBJECTIVE

The aim of this study was to answer the following research question using data from a portion of a larger study: What factors predict the use of complementary therapy among older rural women?

METHODS

Data were collected by telephone interview from a random sample of older residents of 19 rural towns in Montana and North Dakota. Interviews were conducted using a guide that included questions about the use of allopathic and complementary healthcare and related issues such as health status, health problems, and reasons for seeking care. A direct logistic regression analysis was performed on the use of complementary or alternative medicine (CAM) as outcome and eight potential predictors. Data from 156 women were included in this analysis.

RESULTS

A total of 25.6% (n=40) of the women reported using CAM in the recent past. Rural women most likely to use CAM were those who were fairly well educated, not currently married, and in their early older years. They had one or more significant chronic illnesses and lower health-related quality of life due to emotional concerns.

DISCUSSION

By improving the existing understanding of who is or is not likely to use CAM, the results of this study can be used in giving comprehensive care for rural women, including all healthcare practices, self-care and practitioner provided, and complementary and conventional.

Folk medical uses of plant foods in southern Appalachia, United States

An analysis of information obtained from interviews with 660 older native inhabitants of the southern Appalachian region in the United States indicates that plant foods, especially cultivars and materials processed from them, and some wildcrafted plant foods as well, constituted the bulk of the folk materia medica in the 1920s and 1930s. Aside from their use for the treatment of common ailments, many plant foods were, and still are to a lesser extent, valued in the region for cleaning and building blood, cleaning the bowel, and as a source of vitamins and minerals. The dependence on plant foods and wildcrafted medicinal plants, however, appears to have diminished considerably in recent years.

Complementary therapy use among older rural adults

OBJECTIVE

Explore use, cost, and satisfaction with the quality and effectiveness of complementary therapy among older rural adults.

DESIGN

Descriptive survey.

SAMPLE

A random sample of 325 older adults from rural communities throughout Montana and North Dakota.

MEASUREMENTS

Participants were interviewed by telephone.

RESULTS

Only 57 participants (17.5%) had used complementary providers and most sought this care for chronic problems, heard about providers through word-of-mouth information, and were satisfied with the care. A total of 35.7% (116) used self-directed complementary practices and most used these practices for health promotion, heard about them through informal sources, and found them to be at least somewhat helpful. Of the 325 participants, 45.2% (147) used some form of complementary care, e.g., providers, self-directed practices, or both. Participants used as much complementary care as is found in national studies. Most spent relatively little out-of-pocket for complementary care.

CONCLUSIONS

Understanding the health care choices that older rural residents make, including complementary health care, is paramount for a comprehensive approach to meeting their health care needs.

Dynamic coping behaviors and process of parental response to child’s cancer

The purpose of this study was to identify a theoretical construct for the process that Taiwanese parents go through during their child's illness with cancer. Grounded theory methodology was used to gain insight into the parental responses to their child's devastating illness. One core category with five distinct components emerged from the data as parents developed their ability to endure the distress of caring for a child with cancer. "Coming to terms" was the core category. The five distinct components were as follows: confrontation of reality, management of treatments, cognitive/affective shifting, recognition of the situation, and adjusting appropriately. For the parents of those children whose illness proceeded with few complications and those children who had been successfully treated, these components had a sequential pattern. However, for parents of those children whose illnesses were more complicated, changes in clinical status occurred in rapid succession, or simultaneously. Emotional responses of these parents were dynamic; the stages were less obvious and not sequential.

Complementary therapy in critical care settings: a review of surveys and implications for nurses

Critical care nurses have been leaders in this field and need to further expand their influence in the work environment and healthcare system. The time is ideal for initiating meaningful system-wide changes in policy and practice. This review provides an historical context of surveys conducted in a variety of critical care settings in this country. It is important for nurses to become familiar with these studies to communicate better with others and make recommendations based on research. Critical care nurses can maintain their lead by becoming principal investigators in this area of research. In this day and age there is no reason to dismiss or arbitrarily evaluate the use of CAM. Consumer use does not end when crossing over the threshold of a healthcare setting. The focus should be equally spread over safety issues and modalities that can enhance an individual's quality of life. The staff has an ethical and legal responsibility to be aware of and knowledgeable about any healthcare modality practiced by their patients regardless of whether "sufficient" randomized, double-blind controlled studies have been completed.

Use of herbal medicine by elderly Hispanic and non-Hispanic white patients

STUDY OBJECTIVES

To determine the types and prevalence of herbal medicines used by Hispanic and non-Hispanic white individuals aged 65 years and older. Secondary objectives were to compare herbal medicine use according to ethnicity, sex, age, socioeconomic status, and education level, and to determine patients' beliefs about herbal medicines. Use of nonphysician health care providers such as acupuncturists and chiropractors also was assessed.

METHODS

Data for a cross-sectional, interviewer-administered survey were collected at the University of New Mexico Senior Health Center, an ambulatory health care clinic, in Albuquerque, New Mexico, from February 1996-January 1997. To participate in the study, patients had to be at least 65 years of age, established patients at the clinic, and live independently in a community dwelling. They were excluded if they had dementia, lived in an institution, or belonged to any ethnic group other than Hispanic or non-Hispanic white. Ethnicity was determined by asking the patients in which ethnic group they identified themselves.

RESULTS

A total of 186 patients were surveyed: 84 Hispanic (34 men, 50 women) and 102 non-Hispanic white (47 men, 55 women). Of the 186 patients, 91 (49%) admitted to having taken herbal medicines in the previous year. The most common were spearmint, chamomile, aloe vera, garlic, brook-mint, osha, lavender, ginger, ginseng, and camphor. Most of the patients who used herbal medicines were 65-74 years of age and took them primarily for health care maintenance or self-perceived problems.

CONCLUSION

As approximately half of the elderly patients stated that they used herbal medicines, health care providers should be knowledgeable about herbal remedies and provide reliable information to their patients about them in a nonjudgmental manner.

Pattern of use of complementary/alternative medicine (CAM) in epileptic patients in a tertiary care hospital in India

PURPOSE

Many patients use complementary/alternative medicine (CAM) for their health problems especially where long-term treatment is required. Epilepsy is the most prevalent neurological disorder requiring long-term treatment and compliance. The purpose of the study was to establish the pattern of use of CAM in epileptic patients.

METHODS

1000 patients with seizure disorder visiting the Neurology outpatient department were interviewed regarding use of complementary/alternative medicine (CAM) in the past. The pattern of use, persons who recommended CAM and the reasons for trying these therapies and sequence of seeking them was noted in these patients.

RESULTS

Overall 32% of patients had used CAM. Ayurvedic medicine was used most frequently, either alone (43%) or in combination (38%) with other CAM therapies followed by homeopathy (12.5%). Use of CAM was seen among all age groups and at all levels of education and was most frequent in the rural population (67%). Influence of family and friends (50%) was the most common reason for trying these therapies. Most patients (57%) sought CAM providers first before seeking the services of a medical doctor in our study.

CONCLUSION

As more and more patients use CAM, physicians should ask their patients whether they use these therapies and should discuss these practices with their patients in order to safeguard their health.

The use of herbal medicine by older Mexican Americans

BACKGROUND

Little is known about use of herbal medicines by older Mexican Americans. The objective of this study was to determine the characteristics among older Mexican Americans that correlate with use of herbal medicines.

METHODS

We administered a cross-sectional regional sample survey, the 1993-1994 Hispanic Established Populations for the Epidemiologic Study of the Elderly of Mexican Americans, by in-home interviews of noninstitutionalized older Mexican Americans age 65 and over living in Texas, New Mexico, Colorado, Arizona, and California.

RESULTS

The use of herbal medicine in the 2 weeks prior to the interview was reported by 9.8% of the sample. Chamomile and mint were the two most commonly used herbs. Users of herbal medicines were more likely to be women, born in Mexico, over age 75, living alone, and experiencing some financial strain. Having arthritis, urinary incontinence, asthma, and hip fracture were also associated with an elevated use of herbal medicines, whereas heart attacks were not. We found that herbal medicine use was substantially higher among individuals reporting any disability in activities of daily living, poor self-reported health, and depressive symptoms. Herbal medicine use was associated with the use of over-the-counter medications but not with prescription medications. Herbal medicine use was particularly high among respondents who had over 24 physician visits during the year prior to interview.

CONCLUSIONS

Herbal medication use is common among older Mexican Americans, particularly among those with chronic medical conditions, those who experience financial strain, and those who are very frequent users of formal health care services.

The influence of ethnicity on use of herbal remedies in elderly Hispanics and non-Hispanic whites

OBJECTIVE

To compare the use of herbal remedies between elderly, self-identified Hispanics and non-Hispanic whites (NHW).

DESIGN

Cross-sectional, interviewer-administered survey.

PATIENTS/SETTING

186 patients, 65 years and older, at a university-based, ambulatory, senior health center.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Differences in herbal use patterns between Hispanic and NHW participants. Main outcome measures were participants' use of herbal remedies, types of remedies used, medical reason for use, age, sex, Hispanic or NHW ethnicity, income, and education.

RESULTS

Overall, 61% of patients had used an herbal remedy at some time in their lives. A larger proportion of Hispanic subjects used herbal remedies than did NHW subjects (77% versus 47%, respectively). Hispanic subjects preferred to use the raw herb in a tea, whereas NHW subjects preferred processed herbs in a capsule or tablet form. Significantly more Hispanic subjects grew or gathered their own herbs and received their information about herbs from a family member than did NHW subjects. Few subjects in either ethnic group received their information about herbal remedies from an allopathic provider. For both groups, the herbs most often used were yerba buena, manzanilla, poleo, osha, and alhucema. The top perceived medical problems that herbs were used for were health care maintenance, dyspepsia, upper respiratory infection, skin problems, and anxiety/nerves/insomnia.

CONCLUSION

Ethnicity was related to the frequency of herbal use, the choice and preferred form of herb, and the source of knowledge of herbal remedies. Hispanic culture may account for the observed differences.

Alternative therapies and empowerment of older women

There has been a striking increase in Americans' awareness and use of alternative therapies over the last decade. Women, in particular, have been drawn to explore these unconventional health practices, which include herbal medicine, acupuncture, homeopathy, manual therapies, energy healing, and mind-body therapies. From a feminist perspective, the rise in alternative therapies' use in the United States represents a shift in cultural concepts of health from an out-moded patriarchical model which disempowers older women, to a more feminine, holistic model which can reempower older women. Throughout history, older women have developed, applied, and taught the principles and practices of what are now considered alternative healing modalities, in their roles as mothers, expert herbalists, midwives, wise women, and shaman. By becoming familiar with these therapies, older women can increase their control over their health, enhance prevention and self-care, and enjoy a health-care pathway that leads to wholeness in body, mind, and spirit.

Epidemiology of complementary and alternative practices in rheumatology

The increasing prevalence of complementary and alternative medicine usage by the general population and rheumatic patients worldwide is reviewed. The many potential concerns about this type of therapy are addressed, ranging from toxicity issues to changes in behavioral attitudes. Finally, the authors speculate on some major socioeconomic outcomes associated with these therapies.

Use of herbal medicines among consultation-liaison populations. A review of current information regarding risks, interactions, and efficacy

Consultation-liaison psychiatrists evaluate a wide variety of patients who are often disillusioned with conventional medical care and are seeking to gain some measure of control over their illness. With the growing popularity of alternative health care practices, consultation-liaison psychiatrists must learn more about the implications of herbal medicine usage. This review provides an overview of herbal medicines, a vital component of the alternative medicine movement.

Use of unproven therapies by people with Alzheimer's disease

OBJECTIVE

To describe the use of unproven therapies for Alzheimer's disease.

DESIGN

Descriptive survey using a written questionnaire.

PARTICIPANTS

101 primary caregivers of people with Alzheimer's disease who attended Alzheimer's disease support group meetings.

RESULTS

Fifty-five percent of caregivers reported that they had tried at least one alternative therapy to improve the patient's memory. Twenty percent of caregivers tried three or more unproven therapies. Vitamins were used most frequently (84%), and health foods (27%), herbal medicines (11%), "smart pills" (9%), and home remedies (7%) were also tried. Most caregivers reported trying the therapies in the early stage of the illness and did not notice significant improvement in the patient's memory. Twenty-five percent of caregivers had tried unproven therapies for behavior problems. There was no correlation between the use of alternative therapies and the sex of the caregiver, age of the caregiver, level of caregiver frustration, presence of problem behaviors, or perceived level of physician support.

CONCLUSIONS

The use of unproven therapies by people with early Alzheimer's disease is common and cannot be predicted by characteristics of the primary caregiver. Although this use may be understandable, it exposes vulnerable people to possible side effects, increased costs, and possible exploitation. Health care workers should actively inquire about the use of alternative therapies, and explore the reasons behind their use, so that they can better understand and meet the needs of their patients and their caregivers.

Unconventional medicine in the United States. Prevalence, costs, and patterns of use

BACKGROUND

Many people use unconventional therapies for health problems, but the extent of this use and the costs are not known. We conducted a national survey to determine the prevalence, costs, and patterns of use of unconventional therapies, such as acupuncture and chiropractic.

METHODS

We limited the therapies studied to 16 commonly used interventions neither taught widely in U.S. medical schools nor generally available in U.S. hospitals. We completed telephone interviews with 1539 adults (response rate, 67 percent) in a national sample of adults 18 years of age or older in 1990. We asked respondents to report any serious or bothersome medical conditions and details of their use of conventional medical services; we then inquired about their use of unconventional therapy.

RESULTS

One in three respondents (34 percent) reported using at least one unconventional therapy in the past year, and a third of these saw providers for unconventional therapy. The latter group had made an average of 19 visits to such providers during the preceding year, with an average charge per visit of $27.60. The frequency of use of unconventional therapy varied somewhat among socio-demographic groups, with the highest use reported by nonblack persons from 25 to 49 years of age who had relatively more education and higher incomes. The majority used unconventional therapy for chronic, as opposed to life-threatening, medical conditions. Among those who used unconventional therapy for serious medical conditions, the vast majority (83 percent) also sought treatment for the same condition from a medical doctor; however, 72 percent of the respondents who used unconventional therapy did not inform their medical doctor that they had done so. Extrapolation to the U.S. population suggests that in 1990 Americans made an estimated 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all U.S. primary care physicians (388 million). Expenditures associated with use of unconventional therapy in 1990 amounted to approximately $13.7 billion, three quarters of which ($10.3 billion) was paid out of pocket. This figure is comparable to the $12.8 billion spent out of pocket annually for all hospitalizations in the United States.

CONCLUSIONS

The frequency of use of unconventional therapy in the United States is far higher than previously reported. Medical doctors should ask about their patients' use of unconventional therapy whenever they obtain a medical history.

Alternative health care as a control strategy

What does it mean when a patient desires to be in control of an uncontrollable illness or an uncontrollable hospital situation? This paper explores the theme, desire for control, a theme emerging from a recent ethnographic study on the use of alternative health care in a hospital setting. While it may be argued that choosing an alternative practice may be a patient's strategy to control a perceived uncontrollable situation, there are many other ways of looking at the control issue. The data derived from the conceptual reality of the informants in this study are examined in the light of research and theories of perceived control, locus of control and illusion of control.

Aloe vera

We review the scientific literature regarding the aloe vera plant and its products. Aloe vera is known to contain several pharmacologically active ingredients, including a carboxypeptidase that inactivates bradykinin in vitro, salicylates, and a substance(s) that inhibits thromboxane formation in vivo. Scientific studies exist that support an antibacterial and antifungal effect for substance(s) in aloe vera. Studies and case reports provide support for the use of aloe vera in the treatment of radiation ulcers and stasis ulcers in man and burn and frostbite injuries in animals. The evidence for a potential beneficial effect associated with the use of aloe vera is sufficient to warrant the design and implementation of well-controlled clinical trials.