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Ziegler AML, Shannon Z, Long CR, Vining RD, Walter JA, Coulter ID, Goertz CM. Chiropractic Services and Diagnoses for Low Back Pain in 3 U.S. Department of Defense Military Treatment Facilities: A Secondary Analysis of a Pragmatic Clinical Trial. J Manipulative Physiol Ther 2022; 44:690-698. [PMID: 35752500 DOI: 10.1016/j.jmpt.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the diagnoses and chiropractic services performed by doctors of chiropractic operating within 3 military treatment facilities for patients with low back pain (LBP). METHODS This was a descriptive secondary analysis of a pragmatic clinical trial comparing usual medical care (UMC) plus chiropractic care to UMC alone for U.S. active-duty military personnel with LBP. Participants who were allocated to receive UMC plus 6 weeks of chiropractic care and who attended at least 1 chiropractic visit (n = 350; 1547 unique visits) were included in this analysis. International Classification of Diseases and Current Procedural Terminology codes were transcribed from chiropractic treatment paper forms. The number of participants receiving each diagnosis and service and the number of each service on unique visits was tabulated. Low back pain and co-occurring diagnoses were grouped into neuropathic, nociceptive, bone and/or joint, general pain, and nonallopathic lesions categories. Services were categorized as evaluation, active interventions, and passive interventions. RESULTS The most reported pain diagnoses were lumbalgia (66.1%) and thoracic pain (6.6%). Most reported neuropathic pain diagnoses were sciatica (4.9%) and lumbosacral neuritis or radiculitis (2.9%). For the nociceptive pain, low back sprain and/or strain (15.8%) and lumbar facet syndrome (9.2%) were most common. Most reported diagnoses in the bone and/or joint category were intervertebral disc degeneration (8.6%) and spondylosis (6.0%). Tobacco use disorder (5.7%) was the most common in the other category. Chiropractic care was compromised of passive interventions (94%), with spinal manipulative therapy being the most common, active interventions (77%), with therapeutic exercise being most common, and a combination of passive and active interventions (72%). CONCLUSION For the sample in this study, doctors of chiropractic within 3 military treatment facilities diagnosed, managed, and provided clinical evaluations for a range of LBP conditions. Although spinal manipulation was the most commonly used modality, chiropractic care included a multimodal approach, comprising of both active and passive interventions a majority of the time.
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Affiliation(s)
- Anna-Marie L Ziegler
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa.
| | | | - Cynthia R Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | - Robert D Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | | | | | - Christine M Goertz
- Department of Orthopedic Surgery, Duke University, Durham, North Carolina
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Belding JN, Castañeda SF, Jacobson IG, LeardMann CA, Porter B, Powell TM, Kolaja CA, Seelig AD, Matsuno RK, Carey FR, Rivera AC, Trone DW, Sheppard B, Walstrom J, Boyko EJ, Rull RP, For The Millennium Cohort Study Team. The Millennium Cohort Study: The First 20 Years of Research Dedicated to Understanding the Long-Term Health of US Service Members and Veterans. Ann Epidemiol 2021; 67:61-72. [PMID: 34906635 DOI: 10.1016/j.annepidem.2021.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/22/2023]
Abstract
The Millennium Cohort Study, the US Department of Defense's largest and longest running study, was conceived in 1999 to investigate the effects of military service on service member health and well-being by prospectively following active duty, Reserve, and National Guard personnel from all branches during and following military service. In commemoration of the Study's 20th anniversary, this paper provides a summary of its methods, key findings, and future directions. Recruitment and enrollment of the first 5 panels occurred between 2001 and 2021. After completing a baseline survey, participants are requested to complete follow-up surveys every 3 to 5 years. Study research projects are categorized into 3 core portfolio areas (psychological health, physical health, and health-related behaviors) and several cross-cutting areas and have culminated in more than 120 publications to date. For example, some key Study findings include that specific military service-related factors (e.g., experiencing combat, serving in certain occupational subgroups) were associated with adverse health-related outcomes and that unhealthy behaviors and mental health issues may increase following the transition from military service to veteran status. The Study will continue to foster stakeholder relationships such that research findings inform and guide policy initiatives and health promotion efforts.
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Key Words
- Abbreviations
- Army STARRS, Army Study to Assess Risk and Resilience in Servicemembers
- DoD, Department of Defense
- Millennium Cohort Study, military, veterans, deployment, risk factors, protective factors, physical health, mental health, health-related behaviors, longitudinal cohort
- OEF, Operation Enduring Freedom
- OIF, Operation Iraqi Freedom
- OND, Operation New Dawn
- PTSD, posttraumatic stress disorder
- VA, Department of Veterans Affairs
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Affiliation(s)
- Jennifer N Belding
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Sheila F Castañeda
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Isabel G Jacobson
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Cynthia A LeardMann
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Ben Porter
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA; Mississippi State University, Mississippi State, Mississippi, USA
| | - Teresa M Powell
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Claire A Kolaja
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Amber D Seelig
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rayna K Matsuno
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Felicia R Carey
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Anna C Rivera
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Daniel W Trone
- Naval Health Research Center, San Diego, California, USA
| | - Beverly Sheppard
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Jennifer Walstrom
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Edward J Boyko
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rudolph P Rull
- Naval Health Research Center, San Diego, California, USA.
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Mior S, Sutton D, Cancelliere C, French S, Taylor-Vaisey A, Côté P. Chiropractic services in the active duty military setting: a scoping review. Chiropr Man Therap 2019; 27:45. [PMID: 31338157 PMCID: PMC6628474 DOI: 10.1186/s12998-019-0259-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/22/2019] [Indexed: 12/12/2022] Open
Abstract
Background Musculoskeletal injuries are one of the most prevalent battle and non-battle related injuries in the active duty military. In some countries, chiropractic services are accessed to manage such injuries within and outside military healthcare systems; however, there is no recent description of such access nor outcomes. This scoping review aimed to synthesize published literature exploring the nature, models, and outcomes of chiropractic services provided to active duty military globally. Method We employed scoping review methodology. Systematic searches of relevant databases, including military collections and hand searches were conducted from inception to October 22, 2018. We included peer-reviewed English literature with qualitative and quantitative designs, describing chiropractic practice and services delivered to active duty military worldwide. Paired reviewers independently reviewed all citations and articles using a two-phase screening process. Data from relevant articles were extracted into evidence tables and sorted by study type. Results were descriptively analyzed. Results We screened 497 articles and 20 met inclusion criteria. Chiropractic services were commonly provided on-base only in the US. Services were accessed by physician referral and commonly after initiation or non-response to other care. Use of scope of practice was determined by the system/facility, varying from intervention specific to comprehensive services. Back pain with and without radiculopathy accounted for most complaints. Treatment outcomes were reported primarily by case reports. However, two recent randomized trials reported improved pain, disability, and satisfaction when adding chiropractic care to usual medical care compared to usual medical care alone in management of low back pain. Specific reaction time measures in special operation forces military did not improve after chiropractic care compared to wait-list control. Conclusions Our scoping review found the majority of published articles described chiropractic services in the active duty military in the US setting. Recent RCTs suggest a benefit of including chiropractic care to usual medical care in managing back pain in active duty military. Yet despite reported benefits in Australia, Canada, and the US, there is a need for further qualitative, descriptive, and clinical trial data worldwide to inform the role of chiropractic services in active duty military.
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Affiliation(s)
- Silvano Mior
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
| | - Deborah Sutton
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
| | - Daphne To
- Department of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
| | - Carolina Cancelliere
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada
| | - Simon French
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Level 3, 17 Wally’s Walk, North Ryde, NSW 2109 Australia
| | - Anne Taylor-Vaisey
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
| | - Pierre Côté
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada
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Matossian C, McDonald M, Donaldson KE, Nichols KK, MacIver S, Gupta PK. Dry Eye Disease: Consideration for Women's Health. J Womens Health (Larchmt) 2019; 28:502-514. [PMID: 30694724 PMCID: PMC6482917 DOI: 10.1089/jwh.2018.7041] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Dry eye disease (DED) is a multifactorial disorder of the ocular surface and tear homeostasis that can result in discomfort, pain, and visual disturbance. Untreated, DED can become chronic, progressive, and significantly affect an individual's quality of life. Women are disproportionately affected by DED, are diagnosed at a younger age, and experience more severe symptoms compared with men. DED is associated with a wide range of comorbid conditions; there is a strong association between DED and autoimmune disorders, especially those that affect women at many times the rate of men. Treatment response questionnaires indicate women respond better to a wellness model of treatment for DED than men. Furthermore, women's health care-seeking behaviors provide opportunities for general practitioners, specialists, and women's health centers to help identify women with DED or at risk for DED for referral to an eye care specialist. This review of the prevalence of DED in women, and gender and sex-specific aspects of DED, highlight a significant opportunity for action. Earlier diagnosis and treatment of this common but burdensome condition could significantly improve a woman's quality of life.
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Affiliation(s)
| | | | - Kendall E Donaldson
- 3 Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Kelly K Nichols
- 4 School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sarah MacIver
- 5 School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - Preeya K Gupta
- 6 Division of Cornea and Refractive Surgery, Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina
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Beliveau PJH, Wong JJ, Sutton DA, Simon NB, Bussières AE, Mior SA, French SD. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropr Man Therap 2017; 25:35. [PMID: 29201346 PMCID: PMC5698931 DOI: 10.1186/s12998-017-0165-8] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/31/2017] [Indexed: 12/31/2022] Open
Abstract
Background Previous research has investigated utilization rates, who sees chiropractors, for what reasons, and the type of care that chiropractors provide. However, these studies have not been comprehensively synthesized. We aimed to give a global overview by summarizing the current literature on the utilization of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided. Methods Systematic searches were conducted in MEDLINE, CINAHL, and Index to Chiropractic Literature using keywords and subject headings (MeSH or ChiroSH terms) from database inception to January 2016. Eligible studies: 1) were published in English or French; 2) were case series, descriptive, cross-sectional, or cohort studies; 3) described patients receiving chiropractic services; and 4) reported on the following theme(s): utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; or, types of chiropractic services provided. Paired reviewers independently screened all citations and data were extracted from eligible studies. We provided descriptive numerical analysis, e.g. identifying the median rate and interquartile range (e.g., chiropractic utilization rate) stratified by study population or condition. Results The literature search retrieved 14,149 articles; 328 studies (reported in 337 articles) were relevant and reported on chiropractic utilization (245 studies), reason for attending chiropractic care (85 studies), patient demographics (130 studies), and assessment and treatment provided (34 studies). Globally, the median 12-month utilization of chiropractic services was 9.1% (interquartile range (IQR): 6.7%-13.1%) and remained stable between 1980 and 2015. Most patients consulting chiropractors were female (57.0%, IQR: 53.2%-60.0%) with a median age of 43.4 years (IQR: 39.6-48.0), and were employed (median: 77.3%, IQR: 70.3%-85.0%). The most common reported reasons for people attending chiropractic care were (median) low back pain (49.7%, IQR: 43.0%-60.2%), neck pain (22.5%, IQR: 16.3%-24.5%), and extremity problems (10.0%, IQR: 4.3%-22.0%). The most common treatment provided by chiropractors included (median) spinal manipulation (79.3%, IQR: 55.4%-91.3%), soft-tissue therapy (35.1%, IQR: 16.5%-52.0%), and formal patient education (31.3%, IQR: 22.6%-65.0%). Conclusions This comprehensive overview on the world-wide state of the chiropractic profession documented trends in the literature over the last four decades. The findings support the diverse nature of chiropractic practice, although common trends emerged.
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Affiliation(s)
| | - Jessica J. Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada
- Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1 Canada
| | - Deborah A. Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada
| | - Nir Ben Simon
- Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1 Canada
| | - André E. Bussières
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
- Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
- Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, Canada
| | - Silvano A. Mior
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada
- Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1 Canada
| | - Simon D. French
- Department of Public Health Sciences, Queen’s University, Kingston, Canada
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
- Department of Chiropractic, Macquarie University, Sydney, Australia
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6
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Herman PM, Sorbero ME, Sims-Columbia AC. Complementary and Alternative Medicine Services in the Military Health System. J Altern Complement Med 2017; 23:837-843. [DOI: 10.1089/acm.2017.0236] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Madsen C, Vaughan M, Koehlmoos TP. Use of Integrative Medicine in the United States Military Health System. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2017; 2017:9529257. [PMID: 28690665 PMCID: PMC5485330 DOI: 10.1155/2017/9529257] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/05/2017] [Accepted: 05/10/2017] [Indexed: 12/20/2022]
Abstract
Integrative medicine (IM) is a model of care which uses both conventional and nonconventional therapies in a "whole person" approach to achieve optimum mental, physical, emotional, spiritual, and environmental health, and is increasingly popular among patients and providers seeking to relieve chronic or multifactorial conditions. The US Department of Defense (DoD) shows particular interest in and usage of IM for managing chronic conditions including the signature "polytrauma triad" of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD) among its beneficiaries in the Military Health System (MHS). These modalities range from conventional nondrug, nonsurgical options such as cognitive-behavioral therapy to nonconventional options such as acupuncture, chiropractic, and mind-body techniques. These are of particular interest for their potential to relieve symptoms without relying on opiates, which impair performance and show high potential for abuse while often failing to provide full relief. This review describes the use of IM in the MHS, including definitions of the model, common therapies and potential for use, and controversy surrounding the practice. More research is needed to build a comprehensive usage analysis, which in turn will inform sound clinical and financial practice for the MHS and its beneficiaries.
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Affiliation(s)
- Cathaleen Madsen
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Megan Vaughan
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Defense and Veterans Center for Integrative Pain Management, Rockville, MD, USA
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Park CL, Finkelstein-Fox L, Barnes DM, Mazure CM, Hoff R. CAM use in recently-returned OEF/OIF/OND US veterans: Demographic and psychosocial predictors. Complement Ther Med 2016; 28:50-6. [PMID: 27670870 DOI: 10.1016/j.ctim.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/03/2016] [Accepted: 08/16/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Because the use of complementary and alternative medicine (CAM) is increasing among veterans, understanding more about the characteristics of veterans who use CAM is increasingly important. Studies reporting on predictors of use almost always discuss CAM in the aggregate, yet each CAM modality represents a unique approach to healthcare, and each may have different correlates as well as different effectiveness. Very little information is available about veterans' use of each distinct modality, and about psychosocial correlates of various forms of CAM use. DESIGN We analyzed data from wave 1 of the Survey of the Experiences of Returning Veterans (SERV) Study, which included 729 veterans returning from Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF) and Operation New Dawn (OND). SETTING Data were collected by telephone interviews. MAIN MEASURES We examined a range of potentially important correlates of CAM use, including demographics, military experiences, and current mental and physical health. RESULTS Each predictor related to a unique constellation of CAM modalities; not one of the predictors examined was associated with more than half of the 12 modalities. For example, women were more likely to use acupuncture, massage, yoga, meditation and spiritual healing, and age related only to greater use of homeopathy, while deployment injuries related positively to use of chiropractic, nutrition and meditation. CONCLUSIONS Results suggest that in order to understand CAM use, CAM modalities should be considered unique and separate practices. This greater understanding should be useful for future health service provision for veterans.
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Affiliation(s)
- Crystal L Park
- University of Connecticut, Department of Psychological Sciences, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA.
| | - Lucy Finkelstein-Fox
- University of Connecticut, Department of Psychological Sciences, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA.
| | - David M Barnes
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, 39 Broadway, Suite 530, New York, NY 10006, USA.
| | - Carolyn M Mazure
- Yale University School of Medicine, Department of Psychiatry and Women's Health Research at Yale, 135 College Street, Suite 220, New Haven, CT 06510, USA.
| | - Rani Hoff
- Yale University School of Medicine, Department of Psychiatry and Women's Health Research at Yale and VISN1 MIRECC, VA Connecticut Healthcare System, NEPC/182, 950 Campbell Avenue, West Haven, CT 06416, USA.
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Seelig AD, Jacobson IG, Donoho CJ, Trone DW, Crum-Cianflone NF, Balkin TJ. Sleep and Health Resilience Metrics in a Large Military Cohort. Sleep 2016; 39:1111-20. [PMID: 26951391 DOI: 10.5665/sleep.5766] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 01/20/2016] [Indexed: 12/23/2022] Open
Abstract
STUDY OBJECTIVES Examine the relationship between self-reported sleep parameters and indicators of resilience in a US military population (n = 55,021). METHODS Longitudinal analyses (2001-2008) were conducted using subjective data collected from Millennium Cohort Study questionnaires and objective data from military records that included demographics, military health, and deployment information. Subjective sleep duration and insomnia symptoms were collected on the study questionnaire. Resilience metrics included lost work days, self-rated health, deployment, frequency and duration of health care utilization, and early discharge from the military. Generalized estimating equations and survival analyses were adjusted for demographic, military, behavioral, and health covariates in all models. RESULTS The presence of insomnia symptoms was significantly associated with lower self-rated health, more lost work days, lower odds of deployment, higher odds of early discharge from military service early, and more health care utilization. Those self-reporting < 6 h (short sleepers) or > 8 h (long sleepers) of sleep per night had similar findings, except for the deployment outcome in which those with the shortest sleep were more likely to deploy. CONCLUSIONS Poor sleep is a detriment to service members' health and readiness. Leadership should redouble efforts to emphasize the importance of healthy sleep among military service members, and future research should focus on the efficacy of interventions to promote healthy sleep and resilience in this population. COMMENTARY A commentary on this article appears in this issue on page 963.
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Affiliation(s)
| | | | - Carrie J Donoho
- Naval Health Research Center, San Diego, CA.,Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | - Nancy F Crum-Cianflone
- Naval Health Research Center, San Diego, CA.,Naval Medical Center San Diego, San Diego, CA
| | - Thomas J Balkin
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD
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Schuman D. Veterans' Experiences using Complementary and Alternative Medicine for Posttraumatic Stress: A Qualitative Interpretive Meta-Synthesis. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:83-97. [PMID: 26799661 DOI: 10.1080/19371918.2015.1087915] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Combat Veterans struggling with combat-related post(*)traumatic stress disorder and subthreshold symptoms often look outside the conventional behavioral health care system for treatment because standard care has not met their needs. This study utilized a qualitative interpretive metasynthesis to describe the lived experience of combat Veterans seeking complementary and alternative health therapies for posttraumatic stress symptoms. This research aimed to understand what attracts these Veterans to complementary and alternative medicine techniques and how they benefit from their experiences with nonconventional therapies. Findings suggest the need for further research into increasing access and eliminating disparities for Veterans seeking more integrative care.
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Affiliation(s)
- Donna Schuman
- a School of Social Work, The University of Texas at Arlington , Arlington , Texas , USA
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Hernández TD, Brenner LA, Walter KH, Bormann JE, Johansson B. Complementary and alternative medicine (CAM) following traumatic brain injury (TBI): Opportunities and challenges. Brain Res 2016; 1640:139-151. [PMID: 26806403 DOI: 10.1016/j.brainres.2016.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 11/15/2022]
Abstract
Traumatic brain injury (TBI) is highly prevalent and occurs in a variety of populations. Because of the complexity of its sequelae, treatment strategies pose a challenge. Given this complexity, TBI provides a unique target of opportunity for complementary and alternative medicine (CAM) treatments. The present review describes and discusses current opportunitites and challenges associated with CAM research and clinical applications in civilian, veteran and military service populations. In addition to a brief overview of CAM, the translational capacity from basic to clinical research to clinical practice will be described. Finally, a systematic approach to developing an adoptable evidence base, with proof of effectiveness based on the literature will be discussed. Inherent in this discussion will be the methodological and ethical challenges associated with CAM research in those with TBI and associated comorbidities, specifically in terms of how these challenges relate to practice and policy issues, implementation and dissemination. This article is part of a Special Issue entitled SI:Brain injury and recovery.
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Affiliation(s)
- Theresa D Hernández
- Department of Psychology and Neuroscience, University of Colorado at Boulder, United States; Center for Neuroscience, University of Colorado at Boulder, United States; Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), United States.
| | - Lisa A Brenner
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, United States; Department of Neurology, University of Colorado Anschutz Medical Campus, United States
| | | | - Jill E Bormann
- Department of Veteran Affairs, San Diego Healthcare System, Center of Excellence for Stress and Mental Health (CESAMH) and University of San Diego Hahn School of Nursing and Health Sciences/Beyster Institute of Nursing Research, United States
| | - Birgitta Johansson
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
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12
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Petri RP, Delgado RE, McConnell K. Historical and Cultural Perspectives on Integrative Medicine. Med Acupunct 2015. [DOI: 10.1089/acu.2015.1120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Richard P. Petri
- United States Army, Chairman, NATO HFM-195 Task Force, Integrative Medicine Interventions for Military Personnel, El Paso, TX
| | | | - Kimberly McConnell
- Senior Research Associate, Samueli Institute, San Antonio Military Medical Center, San Antonio, TX
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Petri RP, Delgado RE. Integrative Medicine Experience in the U.S. Department of Defense. Med Acupunct 2015; 27:328-334. [PMID: 26543518 DOI: 10.1089/acu.2014.1067] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Over the past 15 years, the use of complementary and alternative medicine (CAM) services, currently described as integrative medicine (IM) when used together with conventional medicine , has continued to rise in the United States. The trends seen in the civilian population are mirrored within the U.S. Military. Objective: A survey was conducted to show the change in the prevalence of integrative medicine services, budgeting of those services, and ongoing research in IM within Department of Defense (DoD) medical treatment facilities (MTFs) from 2005 through 2009. Materials and Methods:Design: The Deputy Chief of Clinical Services or Service equivalent was contacted at fourteen selected DoD MTFs. Comprehensive structured telephone interviews were conducted using a formatted 20-item questionnaire. The questionnaire design was of a mixed model with open and closed formats as well as dichotomous yes/no questions. The questions covered the subject areas of available services, budgeting, and research. The initial survey was conducted in 2005 with a follow-up survey conducted in 2009. Setting: This survey involved DoD MTFs. Main Outcome Measures: The surveys were conducted to determine the prevalence of IM services within selected DoD facilities. Results: There was a steady increase in the number of IM services available in the DoD MTFs from 2005 through 2009. Acupuncture, biofeedback, nutritional counseling, and spiritual healing were the most prevalent IM services in 2009. Funding sources changed from central funding (Offices of the Surgeon General) to Congressional and local funding. Conclusions: It is essential that the DoD medical community provides safe and effective treatments by providing oversight of IM services, collaboration for research, credentialing of practitioners, and establishing educational programs.
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Affiliation(s)
- Richard P Petri
- United States Army , Chairman, NATO HFM-195 Task Force, Integrative Medicine Interventions for Military Personnel, El Paso, TX
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Yeh ML, Lin KC, Chen HH, Wang YJ, Huang YC. Use of traditional medicine and complementary and alternative medicine in Taiwan: a multilevel analysis. Holist Nurs Pract 2015; 29:87-95. [PMID: 25658931 DOI: 10.1097/hnp.0000000000000071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As the selection of a medical modality is not completely independent, environmental and sociocultural contexts of ecological validity are desired. This study aimed to apply a multilevel analysis using the Hierarchical Linear Modeling software to examine predictors of traditional medicine (TM)/complementary and alternative medicine (CAM) use in Taiwan on both individual and division levels. Individual-level data were obtained from the government database involving TM/CAM use and its impact on the population, whereas division-level data were obtained from a government annual report. A total of 2310 individuals from 22 administrative divisions of Taiwan were evaluated in the data analysis, of which 86.9% had used at least 1 TM/CAM modality in the past year. The average division of TM/CAM use was 2.86 modalities in the null model and 4.15 in the full model. Significant relationships were found between TM/CAM use and individual-level variables of gender, educational level, monthly income, perceived health status, experience with Western medical treatment, and the cost, effect, and degree of satisfaction with TM/CAM. At the division level, TM/CAM use was significantly related to aging population, employment status, and the number of medical institutions. With a simultaneous evaluation of the individual-level and division-level influences, it was found that the average division of TM/CAM use increased significantly. The place of residence is an important predictor of TM/CAM use. The age factor in predicting TM/CAM use in this study may be overestimated in the population of 26 to 60 years of age, whereas an aging population is important in the average division of TM/CAM use. Efforts to reform health insurance to completely cover the costs of TM/CAM and to better facilitate equality of access of health care in rural and remote areas are deemed necessary.
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Affiliation(s)
- Mei-Ling Yeh
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC (Drs Yeh, Lin, and Wang); Department of Applied Mathematics, Chung-Yuan Christian University, Taoyuan, Taiwan, ROC (Dr Chen); Department of Nursing, Chang Gung University of Sciences and Technology, Taoyuan, Taiwan, ROC (Dr Wang); and Hengshan Township Public Health, Hsinchu, Taiwan, ROC (Ms Huang)
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Johnson MA, Cosgrove CD. Complementary and Alternative Medicine for Chronic Musculoskeletal Pain. Fed Pract 2015; 32:31-36. [PMID: 30766085 PMCID: PMC6364821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A review of randomized clinical trial studies suggests that acupuncture and spinal manipulation may be effective for the treatment of chronic musculoskeletal pain.
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Affiliation(s)
- Marcia A Johnson
- is a primary care provider in the spinal cord injury clinic and works in quality management, both at the Orlando VAMC in Florida
| | - Claudia Dianne Cosgrove
- is a primary care provider in the spinal cord injury clinic and works in quality management, both at the Orlando VAMC in Florida
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Reed RM, Reed AW, McArdle PF, Miller M, Pollin TI, Shuldiner AR, Steinle NI, Mitchell BD. Vitamin and supplement use among old order amish: sex-specific prevalence and associations with use. J Acad Nutr Diet 2015; 115:397-405.e3. [PMID: 25316108 PMCID: PMC4344902 DOI: 10.1016/j.jand.2014.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 08/15/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) in the form of vitamin and supplement use is increasingly prevalent in the United States. The interplay between CAM use and use of conventional medications is not well studied. We examined this issue in Old Order Amish (OOA), a population lacking several factors known to influence supplement use, whose culture and barriers to conventional medications may result in high rates of supplement use. OBJECTIVE We characterized the patterns of supplement use in OOA, including the extent to which CAM use aggregates in families, and assessed whether higher use of supplements is associated with lower medication use. DESIGN We conducted a cross-sectional study of conventional medications and supplements in 2,372 adult Amish from the Lancaster County, PA, area. Data were collected through face-to-face interviews. Supplements were subcategorized as herbal vs vitamin/mineral supplements. RESULTS Seventy-seven percent of all Amish adults reported current supplement use, whereas 22% reported medication use. Women used supplements more often and used more supplements than men, and familial aggregation of supplement use was stronger in family pairs involving women. Supplement use was associated with less medication use after controlling for age, sex, body mass index, and self-reported histories of hypertension, diabetes, and hyperlipidemia (adjusted odds ratio [OR] 0.96, 95% CI 0.92 to 1.00; P=0.047). This association was driven primarily by use of herbal supplements (adjusted OR 0.94, 95% CI 0.89 to 0.99; P=0.025) as vitamin/mineral supplements were not associated with different use of medication (adjusted OR 0.99, 95% CI 0.90 to 1.09; P=0.8). In analyses limited to cardiovascular medications and cardiovascular supplements in participants with hyperlipidemia, hypertension, or diabetes, supplement use was not associated with conventional medication use. CONCLUSIONS OAA, particularly women, take dietary supplements much more frequently than they use conventional medications. Use of herbal supplements is associated with less use of conventional medications, whereas vitamin/mineral supplement use is not.
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Affiliation(s)
- Robert M. Reed
- University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine
| | - Anna W. Reed
- Franklin Square Hospital, Division of Pediatrics
| | - Patrick F. McArdle
- University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine
- University of Maryland School of Medicine, Division of Endocrinology, Diabetes and Nutrition
| | - Michael Miller
- University of Maryland School of Medicine, Division of Cardiology
| | - Toni I. Pollin
- University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine
- University of Maryland School of Medicine, Division of Endocrinology, Diabetes and Nutrition
| | - Alan R. Shuldiner
- University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine
- University of Maryland School of Medicine, Division of Endocrinology, Diabetes and Nutrition
- Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore Geriatric Research Education and Clinical Center (GRECC)
| | - Nanette I. Steinle
- University of Maryland School of Medicine, Division of Endocrinology, Diabetes and Nutrition
| | - Braxton D. Mitchell
- University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine
- University of Maryland School of Medicine, Division of Endocrinology, Diabetes and Nutrition
- Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore Geriatric Research Education and Clinical Center (GRECC)
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Reinhard MJ, Nassif TH, Bloeser K, Dursa EK, Barth SK, Benetato B, Schneiderman A. CAM utilization among OEF/OIF veterans: findings from the National Health Study for a New Generation of US Veterans. Med Care 2015; 52:S45-9. [PMID: 25397822 DOI: 10.1097/mlr.0000000000000229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) is increasingly seen as an adjunct to traditional plans of care. This study utilized a representative sample of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans and OEF/OIF-era veterans to explore the prevalence and characteristics of CAM users. RESEARCH DESIGN The National Health Study for a New Generation of US Veterans (NewGen) is a longitudinal health study of a population-based cohort of OEF/OIF (deployed) and OEF/OIF-era (nondeployed) veterans. Data from the 2009-2011 NewGen survey (n=20,563) were analyzed to determine prevalence of CAM use by demographic and military characteristics, the types of CAM modalities used, and where the modalities were sought. Results were weighted to the entire population of OEF/OIF and OEF/OIF-era veterans. RESULTS There was no statistically significant association between CAM use and deployment. Those who used Department of Veterans Affairs (VA) health care after separation were more likely to be CAM users compared with those who did not use VA care; however, the majority of veterans using CAM are using it outside the VA health care system. Massage was the most prevalent CAM modality followed by chiropractic treatment; males were less likely to use CAM than women. CONCLUSIONS CAM modalities are being utilized by OEF/OIF veterans for health problems mainly outside the VA. Policymakers should determine appropriate use of these modalities.
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Affiliation(s)
- Matthew J Reinhard
- *War Related Illness and Injury Study Center (WRIISC), Washington DC Veterans Affairs Medical Center †Georgetown University Medical School, Department of Psychiatry ‡American University School of Education, Teaching and Health §US Department of Veterans Affairs, Office of Public Health, Post Deployment Health, Epidemiology Program, Washington, DC ∥Veterans Affairs Greenville NC CBOC ¶East Carolina University, College of Nursing, Greenville, NC
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A Factor Analysis and Exploration of Attitudes and Beliefs Toward Complementary and Conventional Medicine in Veterans. Med Care 2014; 52:S50-6. [DOI: 10.1097/mlr.0000000000000219] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reddy S, Dick AM, Gerber MR, Mitchell K. The effect of a yoga intervention on alcohol and drug abuse risk in veteran and civilian women with posttraumatic stress disorder. J Altern Complement Med 2014; 20:750-6. [PMID: 25211372 PMCID: PMC4195227 DOI: 10.1089/acm.2014.0014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Individuals with posttraumatic stress disorder (PTSD) often exhibit high-risk substance use behaviors. Complementary and alternative therapies are increasingly used for mental health disorders, although evidence is sparse. OBJECTIVES Investigate the effect of a yoga intervention on alcohol and drug abuse behaviors in women with PTSD. Secondary outcomes include changes in PTSD symptom perception and management and initiation of evidence-based therapies. MATERIALS AND METHODS The current investigation analyzed data from a pilot randomized controlled trial comparing a 12-session yoga intervention with an assessment control for women age 18 to 65 years with PTSD. The Alcohol Use Disorder Identification Test (AUDIT) and Drug Use Disorder Identification Test (DUDIT) were administered at baseline, after the intervention, and a 1-month follow-up. Linear mixed models were used to test the significance of the change in AUDIT and DUDIT scores over time. Treatment-seeking questions were compared by using Fisher exact tests. RESULTS The mean AUDIT and DUDIT scores decreased in the yoga group; in the control group, mean AUDIT score increased while mean DUDIT score remained stable. In the linear mixed models, the change in AUDIT and DUDIT scores over time did not differ significantly by group. Most yoga group participants reported a reduction in symptoms and improved symptom management. All participants expressed interest in psychotherapy for PTSD, although only two participants, both in the yoga group, initiated therapy. CONCLUSIONS Results from this pilot study suggest that a specialized yoga therapy may play a role in attenuating the symptoms of PTSD, reducing risk of alcohol and drug use, and promoting interest in evidence-based psychotherapy. Further research is needed to confirm and evaluate the strength of these effects.
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Affiliation(s)
- Shivani Reddy
- Department of General Internal Medicine, Boston University School of Medicine, Boston, MA
- Women's Health, Department of Medicine, VA Boston Healthcare System, Boston, MA
| | | | - Megan R. Gerber
- Department of General Internal Medicine, Boston University School of Medicine, Boston, MA
- Women's Health, Department of Medicine, VA Boston Healthcare System, Boston, MA
| | - Karen Mitchell
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
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Bagnell ME, LeardMann CA, McMaster HS, Boyko EJ, Smith B, Granado NS, Smith TC. The Association of Predeployment and Deployment-Related Factors on Dimensions of Postdeployment Wellness in U.S. Military Service Members. Am J Health Promot 2013; 28:e56-66. [DOI: 10.4278/ajhp.120727-quan-366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To assess the effects of predeployment and deployment-related factors on dimensions of wellness following deployment. Design. Prospective longitudinal study. The dependent variable was dimensions of wellness. Independent variables were measured in terms of modifiable, nonmodifiable, and military factors, such as sex, race/ethnicity, service branch, smoking status, and combat experience. Setting. A large military cohort participating in the Millennium Cohort Study. Subjects. Included 10,228 participants who deployed in support of the operations in Iraq and Afghanistan. Measures. Dimensions of wellness were measured by using standardized instruments assessing self-reported physical health, mental health, and stress. Covariates were measured by using self-reported and electronic data. Analysis. Factors of postdeployment wellness were assessed by using ordinal logistic regression. Results. Most participants (78.7%) were categorized as “moderately well” post deployment. Significant modifiable predeployment predictors of postdeployment wellness included normal/underweight body mass index (odds ratio [OR] = 1.72, p < .05). Military factors significantly associated with wellness included not experiencing combat (OR = .56, p < .05), member of Air Force (OR = 2.02, p < .05) or Navy/Coast Guard (OR = 1.47, p < .05), and combat specialist occupation (OR = 1.22, p < .05). Conclusion. Multiple modifiable factors associated with postdeployment wellness were identified, which may help inform medical and military leadership on potential strategies to ensure a well force. Those trained in combat roles were more likely to be well post deployment though this apparent benefit was not conferred onto those reporting combat experiences.
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Ferraresi M, Clari R, Moro I, Banino E, Boero E, Crosio A, Dayne R, Rosset L, Scarpa A, Serra E, Surace A, Testore A, Colombi N, Piccoli BG. Reiki and related therapies in the dialysis ward: an evidence-based and ethical discussion to debate if these complementary and alternative medicines are welcomed or banned. BMC Nephrol 2013; 14:129. [PMID: 23799960 PMCID: PMC3694469 DOI: 10.1186/1471-2369-14-129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 06/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Complementary and Alternative Medicines (CAMs) are increasingly practiced in the general population; it is estimated that over 30% of patients with chronic diseases use CAMs on a regular basis. CAMs are also used in hospital settings, suggesting a growing interest in individualized therapies. One potential field of interest is pain, frequently reported by dialysis patients, and seldom sufficiently relieved by mainstream therapies. Gentle-touch therapies and Reiki (an energy based touch therapy) are widely used in the western population as pain relievers.By integrating evidence based approaches and providing ethical discussion, this debate discusses the pros and cons of CAMs in the dialysis ward, and whether such approaches should be welcomed or banned. DISCUSSION In spite of the wide use of CAMs in the general population, few studies deal with the pros and cons of an integration of mainstream medicine and CAMs in dialysis patients; one paper only regarded the use of Reiki and related practices. Widening the search to chronic pain, Reiki and related practices, 419 articles were found on Medline and 6 were selected (1 Cochrane review and 5 RCTs updating the Cochrane review). According to the EBM approach, Reiki allows a statistically significant but very low-grade pain reduction without specific side effects. Gentle-touch therapy and Reiki are thus good examples of approaches in which controversial efficacy has to be balanced against no known side effect, frequent free availability (volunteer non-profit associations) and easy integration with any other pharmacological or non pharmacological therapy. While a classical evidence-based approach, showing low-grade efficacy, is likely to lead to a negative attitude towards the use of Reiki in the dialysis ward, the ethical discussion, analyzing beneficium (efficacy) together with non maleficium (side effects), justice (cost, availability and integration with mainstream therapies) and autonomy (patients' choice) is likely to lead to a permissive-positive attitude. SUMMARY This paper debates the current evidence on Reiki and related techniques as pain-relievers in an ethical framework, and suggests that physicians may wish to consider efficacy but also side effects, contextualization (availability and costs) and patient's requests, according also to the suggestions of the Society for Integrative Oncology (tolerate, control efficacy and side effects).
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Affiliation(s)
- Martina Ferraresi
- SS Nephrology ASOU, san Luigi (regione Gonzole 10), Orbassano 10043, Torino, Italy.
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Goertz C, Marriott BP, Finch MD, Bray RM, Williams TV, Hourani LL, Hadden LS, Colleran HL, Jonas WB. Military report more complementary and alternative medicine use than civilians. J Altern Complement Med 2013; 19:509-17. [PMID: 23323682 DOI: 10.1089/acm.2012.0108] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The study objective was to estimate complementary and alternative medicine (CAM) use among active duty military and compare data with civilian use. DESIGN A global survey on CAM use in the 12 previous months was conducted. Final participants (16,146) were stratified by gender, service, region, and pay grade. Analysis included prevalence of CAM use, demographic and lifestyle characteristics. RESULTS Approximately 45% of respondents reported using at least one type of CAM therapy. Most commonly used therapies were as follows: prayer for one's own health (24.4%), massage therapy (14.1%), and relaxation techniques (10.8%). After exclusion of prayer for one's own health, adjusting to the 2000 U.S. census, overall CAM use in the military (44.5%) was higher than that in comparable civilian surveys (36.0% and 38.3%). CONCLUSIONS Military personnel reported using three CAM stress-reduction therapies at 2.5-7 times the rate of civilians. Among the military, high utilization of CAM practices that reduce stress may serve as markers for practitioners assessing an individual's health and well-being.
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