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Maunder A, Arentz S, Armour M, Costello MF, Ee C. Establishing key components of naturopathic management of women with diminished ovarian reserve: A Delphi study. Complement Ther Clin Pract 2024; 55:101839. [PMID: 38316080 DOI: 10.1016/j.ctcp.2024.101839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Alison Maunder
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - Susan Arentz
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Michael F Costello
- Women's Health, UNSW and Royal Hospital for Women and Monash IVF, Sydney, NSW, Australia
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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Maunder A, Arentz S, Armour M, Costello MF, Ee C. Health needs, treatment decisions and experience of traditional complementary and integrative medicine use by women with diminished ovarian reserve: A cross-sectional survey. Aust N Z J Obstet Gynaecol 2024. [PMID: 38514899 DOI: 10.1111/ajo.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024]
Abstract
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.
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Affiliation(s)
- Alison Maunder
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Susan Arentz
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Michael F Costello
- Women's Health, University of NSW, Sydney, New South Wales, Australia
- Royal Hospital for Women, Sydney, New South Wales, Australia
- Monash IVF, Sydney, New South Wales, Australia
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
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Maunder A, Arentz S, Armour M, Costello MF, Ee C. Effectiveness of naturopathy for pregnancy in women with diminished ovarian reserve: feasibility randomized controlled trial. Reprod Biomed Online 2024; 48:103844. [PMID: 38579664 DOI: 10.1016/j.rbmo.2024.103844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/20/2023] [Accepted: 01/11/2024] [Indexed: 04/07/2024]
Abstract
RESEARCH QUESTION Is conducting a randomized control trial (RCT) to assess the effectiveness of whole-system naturopathy in improving pregnancy rates among women with diminished ovarian reserve (DOR) feasible? DESIGN A two-arm, parallel group, assessor-blinded feasibility RCT was conducted. Women with DOR, trying to conceive naturally or by ART, were randomly assigned to naturopathy plus usual care, or usual care alone for 16 weeks. Primary outcomes were feasibility (recruitment, adherence, retention rates), acceptability and safety. Secondary outcomes included ongoing pregnancy rates, live birth rates and health-related outcomes (mental health, quality of life, diet, exercise, sleep and weight). Statistical significance of the differences between the two groups (P-values) were exploratory. RESULTS One hundred and fifteen women completed the screening survey between March and November 2022. Of these, 66 women were assessed for eligibility and 41 (62%) consented. Recruitment resulted in seven enrolments each month. All 41 participants (100%) adhered to the intervention, 38 (93%) completed end-point questionnaires, 32 (78%) found study participation to be acceptable and 18 out of 21 (86%) from the intervention group would recommend a naturopathic intervention to other women with DOR. The naturopathic treatment was associated with only mild and temporary adverse events. No between-group differences were observed for pregnancy and live birth rates. CONCLUSION The evaluation of whole-system naturopathy through a RCT was feasible and the treatment was acceptable and well tolerated according to women with DOR. Outcomes from this study will help inform sample size calculations powered for fertility outcomes for future RCTs on this topic.
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Affiliation(s)
- Alison Maunder
- NICM Health Research Institute, Western Sydney University, Penrith NSW Australia..
| | - Susan Arentz
- NICM Health Research Institute, Western Sydney University, Penrith NSW Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith NSW Australia
| | - Michael F Costello
- Women's Health, UNSW and Royal Hospital for Women and Monash IVF, Sydney NSW Australia
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith NSW Australia
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Hunter J, Arentz S, Yang G, Goldenberg J, Myers SP, Mertz D, Leeder S. Zinc for the prevention and treatment of SARS-CoV-2 and other acute viral respiratory infections – a living rapid review and meta-analysis. Eur J Integr Med 2021. [PMCID: PMC8696042 DOI: 10.1016/j.eujim.2021.101902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Hunter J, Arentz S, Deed G, Dunning T. Integrating complementary medicine into a clinical guideline for diabetes palliative care. Eur J Integr Med 2021. [DOI: 10.1016/j.eujim.2021.101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hunter J, Arentz S, Goldenberg J, Yang G, Beardsley J, Myers SP, Mertz D, Leeder S. Zinc for the prevention or treatment of acute viral respiratory tract infections in adults: a rapid systematic review and meta-analysis of randomised controlled trials. BMJ Open 2021; 11:e047474. [PMID: 34728441 PMCID: PMC8578211 DOI: 10.1136/bmjopen-2020-047474] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the benefits and risks of zinc formulations compared with controls for prevention or treatment of acute viral respiratory tract infections (RTIs) in adults. METHOD Seventeen English and Chinese databases were searched in April/May 2020 for randomised controlled trials (RCTs), and from April/May 2020 to August 2020 for SARS-CoV-2 RCTs. Cochrane rapid review methods were applied. Quality appraisals used the Risk of Bias 2.0 and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS Twenty-eight RCTs with 5446 participants were identified. None were specific to SARS-CoV-2. Compared with placebo, oral or intranasal zinc prevented 5 RTIs per 100 person-months (95% CI 1 to 8, numbers needed to treat (NNT)=20, moderate-certainty/quality). Sublingual zinc did not prevent clinical colds following human rhinovirus inoculations (relative risk, RR 0.96, 95% CI 0.77 to 1.21, moderate-certainty/quality). On average, symptoms resolved 2 days earlier with sublingual or intranasal zinc compared with placebo (95% CI 0.61 to 3.50, very low-certainty/quality) and 19 more adults per 100 were likely to remain symptomatic on day 7 without zinc (95% CI 2 to 38, NNT=5, low-certainty/quality). There were clinically significant reductions in day 3 symptom severity scores (mean difference, MD -1.20 points, 95% CI -0.66 to -1.74, low-certainty/quality), but not average daily symptom severity scores (standardised MD -0.15, 95% CI -0.43 to 0.13, low-certainty/quality). Non-serious adverse events (AEs) (eg, nausea, mouth/nasal irritation) were higher (RR 1.41, 95% CI 1.17 to 1.69, NNHarm=7, moderate-certainty/quality). Compared with active controls, there were no differences in illness duration or AEs (low-certainty/quality). No serious AEs were reported in the 25 RCTs that monitored them (low-certainty/quality). CONCLUSIONS In adult populations unlikely to be zinc deficient, there was some evidence suggesting zinc might prevent RTIs symptoms and shorten duration. Non-serious AEs may limit tolerability for some. The comparative efficacy/effectiveness of different zinc formulations and doses were unclear. The GRADE-certainty/quality of the evidence was limited by a high risk of bias, small sample sizes and/or heterogeneity. Further research, including SARS-CoV-2 clinical trials is warranted. PROSPERO REGISTRATION NUMBER CRD42020182044.
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Affiliation(s)
- Jennifer Hunter
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Susan Arentz
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Joshua Goldenberg
- Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon, USA
| | - Guoyan Yang
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | | | - Stephen P Myers
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, New South Wales, Australia
| | - Dominik Mertz
- Division of Infectious Diseases, Department of Medicine, Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Leeder
- The Menzies Centre for Health Policy, The University of Sydney, Sydney, New South Wales, Australia
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Ee C, Levett K, Smith C, Armour M, Dahlen HG, Chopra P, Maroun P, Rao VS, Avard N, Grant S, Keedle H, Armour S, Arentz S, Cave AE, Sutcliffe K, Templeman K. Complementary medicines and therapies in clinical guidelines on pregnancy care: A systematic review. Women Birth 2021; 35:e303-e317. [PMID: 34419374 DOI: 10.1016/j.wombi.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is a need for evidence-based guidance on complementary medicines and therapies (CMT) use during pregnancy due to high prevalence of use and lack of guidance on the balance of benefit and harms. AIM Evaluate the extent to which current clinical practice guidelines relevant to Australian healthcare professionals make clear and unambiguous recommendations about CMT use in pregnancy, and synthesise these recommendations. METHODS The search included EMBASE, PubMed, the National Health and Medical Research Council's Clinical Practice Guidelines Portal, and websites of Australian maternity hospitals and professional/not-for-profit organisations for published guidelines on pregnancy care. Data were synthesised narratively. Guidelines were appraised by two independent reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. FINDINGS A total of 48 guidelines were found, of which 41% provided recommendations that were not limited to routine vitamin and mineral supplementation. There were wide variations in recommendations, particularly for vitamin D and calcium. There was some consensus on recommending ginger and vitamin B6 for nausea and vomiting, and additional supplementation for women with obesity. Guidelines generally scored poorly in the domains of editorial independence and rigour of development. DISCUSSION There is a lack of guidance with regard to appropriate CMT use during pregnancy, which may result in less-than-optimal care. Inconsistency between guidelines may lead to variations in care. CONCLUSION Guidelines should include clear and unambiguous guidance on appropriate CMT use during pregnancy, be based on a structured search of the evidence and informed by stakeholder engagement.
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Affiliation(s)
- Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - Kate Levett
- School of Medicine, The University of Notre Dame Australia, Broadway, NSW, Australia.
| | - Caroline Smith
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.
| | - Prakshi Chopra
- Obstetrics and Gynaecology Department, Canberra Hospital, Canberra, ACT, Australia.
| | - Paulette Maroun
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists, East Melbourne, VIC, Australia.
| | - Vibhuti S Rao
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - Nicole Avard
- Next Practice Health, Erina, Sydney, NSW, Australia.
| | - Suzanne Grant
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.
| | - Susanne Armour
- Maternity Service, Wollongong Hospital, Wollongong, NSW, Australia.
| | - Susan Arentz
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - Adele E Cave
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - Kerry Sutcliffe
- School of Medicine, The University of Notre Dame Australia, Broadway, NSW, Australia.
| | - Kate Templeman
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
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Arentz S, Smith C, Redmond R, Abbott J, Armour M. A cross-sectional study of traditional Chinese medicine practitioner's knowledge, treatment strategies and integration of practice of chronic pelvic pain in women. BMC Complement Med Ther 2021; 21:174. [PMID: 34167548 PMCID: PMC8229696 DOI: 10.1186/s12906-021-03355-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/01/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Chronic pelvic pain (CPP) in women is persistent, intermittent cyclical and non-cyclical lower abdominal pain, lasting for more than 6 months. Traditional Chinese Medicine (TCM) is a popular treatment option for women's health conditions, but little is known about how treatment for CPP is delivered by TCM practitioners. The aim of this survey was to explore practitioners understanding and treatment of women with CPP, and how they integrate their management and care into the health care system. METHOD An online cross-sectional survey of registered TCM practitioners in Australia and New Zealand between May and October 2018. Survey domains included treatment characteristics (e.g. frequency), evaluation of treatment efficacy, referral networks, and sources of information that informed clinical decision making. RESULTS One hundred and twenty-two registered TCM practitioners responded to this survey, 91.7% reported regular treatment of women with CPP. Treatment decisions were most-often guided by a combination of biomedical and TCM diagnosis (77.6%), and once per week was the most common treatment frequency (66.7%) for acupuncture. Meditation (63.7%) and dietary changes (57.8%) were other commonly used approaches to management. The effectiveness of treatment was assessed using multiple approaches, most commonly pain scales, (such as the numeric rating scale) and any change in use of analgesic medications. Limitations to TCM treatment were reported by over three quarters (83.7%) of practitioners, most commonly due to cost (56.5%) and inconvenience (40.2%) rather than safety or lack of efficacy. Sources informing practice were most often Integration within the wider healthcare system was common with over two thirds (67.9%) receiving referrals from health care providers. CONCLUSION TCM practitioners seeing women with various CPP symptoms, commonly incorporate both traditional and modern diagnostic methods to inform their treatment plan, monitor treatment progress using commonly accepted approaches and measures and often as a part of multidisciplinary healthcare for women with CPP.
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Affiliation(s)
- Susan Arentz
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Caroline Smith
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Rebecca Redmond
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
- Office of Research, Endeavour College of Natural Health, Fortitude Valley, QLD, Australia
| | - Jason Abbott
- School of Women's and Children's Health, University of New South Wales, Barker Street, Randwick, NSW, 2031, Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Armour M, Al-Dabbas MA, Ee C, Smith CA, Ussher J, Arentz S, Lawson K, Abbott J. The effectiveness of a modified Gui Zhi Fu Ling Wan formulation (Gynoclear™) for the treatment of endometriosis: a study protocol for a placebo-controlled, double-blind, randomised controlled trial. Trials 2021; 22:299. [PMID: 33883001 PMCID: PMC8058744 DOI: 10.1186/s13063-021-05265-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Endometriosis is the presence of tissue similar to that of the endometrium outside the uterine cavity and is the most common cause of chronic pelvic pain. Current non-surgical treatments such as non-steroidal anti-inflammatories, oral contraceptive pills and hormonal treatments have limited effectiveness, and the side effect profile is bothersome. This study will evaluate the efficacy of Gynoclear™ by change in endometriosis-related pain based on the Endometriosis Pain Daily Diary (EPPD) scores. Methods This randomised, double-blind, placebo-controlled trial will recruit a minimum of 90 adult participants across Australia who have a laparoscopic visualisation/confirmation of endometriosis in the last 5 years and have current moderate or greater pelvic pain. Participants will be randomly allocated in a 1:1 ratio to receive either Gynoclear™ (active) or placebo. Gyncolear’s active ingredients are Carthamus tinctorius (Safflower), Cinnamomum cassia (Chinese cinnamon), Poria cocos (Hoelen), Paeonia suffriticosa (Tree peony), Paeonia lactiflora (Peony) and Salvia miltiorrhiza (Red sage). Participants are asked to complete a total of 5 months’ worth of pain diary entries via the EPDD v3, including 1-month screening, 2-month treatment period and 1-month post-treatment follow-up. The primary outcome variable is change in endometriosis-related pain based on the EPDD v3 scores. Secondary outcomes include change in health-related quality of life via the Endometriosis Health Profile (EHP-30), SF-12 and EQ-5D scores as well as changes in rescue analgesic usage, dyspareunia and fatigue via the EPDD. Discussion This study will determine the safety and efficacy of Gynoclear™ to reduce the severity and duration of non-cyclical pelvic pain, dysmenorrhoea, dyspareunia and other symptoms of endometriosis. Study outcomes will be of interest to health professionals and members of the public who suffer from endometriosis. Trial registration Australia and New Zealand Clinical Trials Registry ACTRN12619000807156. Registered on 3 June 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05265-x.
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Affiliation(s)
- Mike Armour
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Translational Health Research Institute (THRI), Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Mahmoud A Al-Dabbas
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Caroline A Smith
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.,Translational Health Research Institute (THRI), Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Jane Ussher
- Translational Health Research Institute (THRI), Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Susan Arentz
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Kenny Lawson
- Translational Health Research Institute (THRI), Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Jason Abbott
- University of New South Wales, Royal Hospital for Women, Randwick, NSW, 2031, Australia
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Arentz S, Smith CA, Abbott J, Bensoussan A. Perceptions and experiences of lifestyle interventions in women with polycystic ovary syndrome (PCOS), as a management strategy for symptoms of PCOS. BMC Womens Health 2021; 21:107. [PMID: 33731099 PMCID: PMC7968330 DOI: 10.1186/s12905-021-01252-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/07/2021] [Indexed: 12/30/2022]
Abstract
Background The international clinical practice guidelines for PCOS emphasize diet and exercise as first-line management of clinical signs and symptoms. This study aimed to describe the patterns, perceptions and experiences of lifestyle interventions for women in the community with PCOS. Method An electronic survey of 493 members of two PCOS consumer support groups, collected by cloud-based Survey Monkey, described women’s types and patterns of diet and exercise, experiences and perceptions of effectiveness. Women were recruited from the Polycystic Ovary Association of Australia (POSAA) and from the Facebook group, PCOS University Research Group. Associations between participants perceptions of effectiveness, and diet types and exercise patterns were assessed using logistic regression. Response bias for the POSAA group was assessed with a continuum of resistance model. Results 91% of POSAA members and 311 Facebook group members aged 16–50 years responded to the survey. Nearly all women reported adjusting their dietary and exercise practices with the aim to improve their health and/or PCOS (82% and 73% respectively), however less than 13% reported achievement of health goals (12.2% and 8.1% respectively). Low carbohydrate, high protein diets, and vigorous activity were associated with self-perceived effectiveness (r.0.16, p < 0.01; r.0.15 p < 0.01 and r.0.2 p < 0.01 respectively). Barriers for lifestyle interventions included psychosocial factors. Response bias was not assessed for the Facebook group, however self-reported PCOS aligned with prevalence of clinical phenotypes and suggests results are generalizable to clinical populations of women with PCOS, who are responsible for self-directing and administering lifestyle interventions to manage their PCOS. Conclusions Perceptions of effectiveness for lifestyle interventions by women with PCOS may be complicated by a lack of rigorous evidence. The strength of recommendations in clinical practice guidelines may be enhanced by clinical trials investigating flexible and feasible lifestyle interventions for women in the community with PCOS. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01252-1.
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Affiliation(s)
- Susan Arentz
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Caroline A Smith
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Jason Abbott
- School of Women's and Children's Health, University of New South Wales, Barker Street, Randwick, NSW, 2031, Australia
| | - Alan Bensoussan
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Arentz S, Hunter J, Yang G, Goldenberg J, Beardsley J, Myers SP, Mertz D, Leeder S. Zinc for the prevention and treatment of SARS-CoV-2 and other acute viral respiratory infections: a rapid review. Adv Integr Med 2020; 7:252-260. [PMID: 32837895 PMCID: PMC7395818 DOI: 10.1016/j.aimed.2020.07.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The global COVID-19 pandemic has prompted an urgent search for interventions to prevent and treat SARS-CoV-2. Higher risk of infection and adverse outcomes coincide with populations with chronic diseases and elderly who are at risk of zinc deficiency. Through several mechanisms zinc may prevent, reduce severity and duration of symptoms. METHOD An a priori protocol was registered with PROSPERO on 27th April 2020 (CRD42020182044). Eight databases (one Chinese) and four clinical trial registries (one Chinese) were searched for randomised and quasi-randomised controlled trials (RCTs), evaluating single or adjunct zinc against placebo or active controls, for prevention and/or treatment of SARS-CoV-2, other coronaviruses or related infections. RR constraints included not searching bibliographies or contacting authors, single reviewers with calibration and second reviewer checking, meta-analyses and quality appraisal of critical and study primary outcomes only and reporting results as they became available. RESULTS 118 publications of 1,627 records met the inclusion criteria (35 Chinese and 83 English publications), 32 for prevention, 78 for treatment and 8 for both. Four RCTs specific to SARS-CoV-2 are ongoing; two are investigating zinc for prevention and two for treatment. As of 7 July 2020, no results were available. A wide range of zinc forms, including nasal spray/gel, lozenges, liquid, tablets and intramuscular were investigated. CONCLUSION Currently, indirect evidence suggests zinc may potentially reduce the risk, duration and severity of SARS-CoV-2 infections, particularly for populations at risk of zinc deficiency including people with chronic disease co-morbidities and older adults. Direct evidence to determine if zinc is effective for either prevention or treatment of SARS-CoV-2 is pending. In the interim, assessing zinc status of people with chronic diseases and older adults, as part of a SARS-CoV-2 clinical work-up, is reasonable as both groups have a higher risk of zinc deficiency/insufficiency and poorer outcomes from SARS-CoV-2.
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Affiliation(s)
- Susan Arentz
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Jennifer Hunter
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Guoyan Yang
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Joshua Goldenberg
- Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon, United States
| | - Jennifer Beardsley
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon, United States
| | - Stephen P Myers
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- NatMed Research Unit, Division of Research, Southern Cross University, Lismore, New South Wales, Australia
| | - Dominik Mertz
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Leeder
- Menzies Centre for Health Policy, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Hunter J, Arentz S, Goldenberg J, Yang G, Beardsley J, Lee MS, Myers SP. Corrigendum to "Choose your shortcuts wisely: COVID-19 rapid reviews of traditional, complementary and integrative medicine" [Integr Med Res 2020; 9: 100484]. Integr Med Res 2020; 10:100690. [PMID: 33294366 PMCID: PMC7695955 DOI: 10.1016/j.imr.2020.100690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
[This corrects the article DOI: 10.1016/j.imr.2020.100484.].
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Affiliation(s)
- Jennifer Hunter
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Susan Arentz
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Joshua Goldenberg
- Helfgott Research Institute, National University of Natural Medicine, Portland, USA
| | - Guoyan Yang
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | | | - Myeong Soo Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Stephen P Myers
- NICM Health Research Institute, Western Sydney University, Penrith, Australia.,NatMed Research Unit, Division of Research, Southern Cross University, Lismore, Australia
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Hunter J, Arentz S, Goldenberg J, Yang G, Beardsley J, Lee MS, Myers SP. Choose your shortcuts wisely: COVID-19 rapid reviews of traditional, complementary and integrative medicine. Integr Med Res 2020; 9:100484. [PMID: 32837904 PMCID: PMC7388820 DOI: 10.1016/j.imr.2020.100484] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 12/31/2022] Open
Abstract
Background: The COVID-19 pandemic has led to an explosion of rapid reviews geared towards providing time sensitive answers for clinical and policy decision-makers. Rapid reviews (RRs) strike a balance between rigour and rapidity to minimise bias and optimise transparency within specified constraints. Methods: This review article appraised the methods and reporting standards of a convenience sample of RR protocols and RRs of COVID-19 clinical management questions, published in the first six-months of 2020. Inclusion criteria were all RR protocols evaluating traditional, complementary, and integrative medicine (TCIM) registered on PROSPERO, and all RRs indexed on PubMed or published on the Oxford COVID-19 Evidence Service. A purpose-specific 9-item reporting checklist reflecting recommended minimum requirements for RRs was applied. Findings were synthesised and narrated in the context of methodological considerations for conducting and reporting RRs of TCIM. Results: Included studies were five RR protocols of TCIM and 16 RRs, of which five considered TCIM. Wide variations in RR methods were proposed or applied, as were the reporting standards. All five RRs that evaluated TCIM had the lowest reporting standards that limited reproducibility and transparency. Despite accepted recommendations, most RRs did not publish a protocol. Conclusions: We propose that specific research disciplines, such as TCIM, have a uniqueness that may lead to unacceptable outputs if minimum methodological standards are not applied. The recommended minimum requirements will optimise the credibility of rapid reviews of TCIM and limit the risk of prematurely disregarding a potentially effective intervention.
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Affiliation(s)
- Jennifer Hunter
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Susan Arentz
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Joshua Goldenberg
- Helfgott Research Institute, National University of Natural Medicine, Portland, USA
| | - Guoyan Yang
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Jennifer Beardsley
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Myeong Soo Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Stephen P. Myers
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
- NatMed Research Unit, Division of Research, Southern Cross University, Lismore, Australia
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Arentz S, Hunter J, Deed G. Integrating Traditional and Complementary Medicine Recommendations into Clinical Practice Guidelines for People with Diabetes in Need of Palliative and End-of-Life Care: A Scoping Review. J Altern Complement Med 2020; 26:571-591. [PMID: 32673080 DOI: 10.1089/acm.2020.0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives: This study was conducted before an evidence review on Traditional and Complementary Medicine (TCM) to update the clinical practice guidelines (CPGs): "Deciding palliative and end-of-life (P/EoL) care for people with diabetes." The aim was to frame the PICO (population/problems, interventions/comparisons, and outcomes), ascertain their importance, and identify other modifying factors for grading recommendations. Design: A systematic scoping review mapped information about diabetes P/EoL problems and outcomes, TCM use, provision, benefits and risks, and stakeholder preferences and values. Thirteen electronic databases were searched in 2017/18 until no new information was identified. Relevant data were extracted, rated for quality, directness, and relevance, and synthesized using triangulation methods. Excluded was diabetes prevention or treatment, as this is not an important P/EoL problem. Results: Of the 228 included articles, except for diabetes P/EoL problems, insufficient direct evidence led to data being extrapolated from either adults with diabetes or any P/EoL diagnosis. The findings affirmed that caring for people with diabetes in need of P/EoL care is complex due to multiple fluctuating needs that are influenced by the P/EoL trajectories (stable, unstable, deteriorating, terminal, or bereaved), multimorbidity, and difficult-to-manage chronic and acute problems. The only problem specific to diabetes P/EoL care, was unstable glycemia. Over 50 TCM interventions commonly used by patients and/or provided by services were identified, of which, many might simultaneously address multiple problems and 18 had been appraised in systematic reviews. Physical and psychologic symptom reliefs were most often evaluated; however, these were only one aspect of a "good death." Other important outcomes were the quality and location of care, personal agency, relationships, preparations for the dying process, spirituality, and affirmation of the whole person. Other important modifying factors included opportunity costs, affordability, availability, preferences, cultural appropriateness, and alignment with beliefs about the meaning of illness and death. Conclusions: There is a role for TCM in the multidisciplinary holistic P/EoL care of people with diabetes. Due to the paucity of evidence specific to this population, the generalizability of some of these results is broader and the updated CPG will also need to consider indirect evidence from other patient groups. Along with recommendations about indications for TCM use, the CGP should provide guidance on ceasing unnecessary interventions, reducing polypharmacy and managing unstable glycemia is required. Before ceasing a TCM, a broader risk-benefit analysis is recommended, as unlike many conventional therapies, there may be multiple benefits warranting its continuation.
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Affiliation(s)
- Susan Arentz
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Jennifer Hunter
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Gary Deed
- Metabolism Ageing Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Hunter J, Arentz S, Goldenberg J, Yang G, Beardsley J, Mertz D, Leeder S. Rapid review protocol: Zinc for the prevention or treatment of COVID-19 and other coronavirus-related respiratory tract infections. Integr Med Res 2020; 9:100457. [PMID: 32690999 PMCID: PMC7308745 DOI: 10.1016/j.imr.2020.100457] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 01/14/2023] Open
Abstract
Background The global COVID-19 pandemic has prompted an urgent search for effective interventions. SARS-CoV-2 mortality/morbidity risk increases with age and for those chronic disease co-morbidities, both of which are associated with lower zinc status, as is the risk of infection. Methods Rapid review methods will be applied to a systematic review of zinc for the prevention or treatment of SARS-CoV-2 and viral respiratory tract infections in humans. Included are published studies reporting randomised and quasi-randomised controlled trials that compare zinc intervention to placebo and/or other comparator interventions. English and Chinese language databases will be searched for primary studies of viral respiratory tract infections and clinical trial registries for SARS-CoV-2 infections. Due to concerns about indirectness, studies evaluating non-SARS-CoV-2 coronavirus infections will be rated down by one level, and non-specific or confirmed non-coronavirus viral infections will be rated down by two levels. Review constraints include (1) using Google translate when screening articles published in languages other than English or Chinese and limited translation (2) following calibration, only one reviewer will screen articles, extract data, appraise quality and conduct the analysis, (3) prioritising data extraction and meta-analyses of SARS-CoV-2 studies and critical outcomes of other viral infections, followed by high risk groups and (4) reporting important preliminary findings prior to peer review if necessary. Discussion The application of these rapid review methods and broadening the inclusion criteria to include other coronavirus-related viral respiratory tract infections aims to enable a timely evidence appraisal of priority research questions and dissemination of results. Study registration PROSPERO CRD42020182044.
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Affiliation(s)
- Jennifer Hunter
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Susan Arentz
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Joshua Goldenberg
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Guoyan Yang
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Jennifer Beardsley
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia.,Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA.,Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Menzies Centre for Health Policy, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Dominik Mertz
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Stephen Leeder
- Menzies Centre for Health Policy, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Davenport C, Arentz S, Sekyere E, Steel A. Standard or Activated B-Vitamins for reducing stress in higher education students: A Randomised Control Trial. Advances in Integrative Medicine 2019. [DOI: 10.1016/j.aimed.2019.03.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arentz S, Smith C, Abbott J, Bensoussan A. Clinical trials for the real world. Advances in Integrative Medicine 2019. [DOI: 10.1016/j.aimed.2019.03.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Arentz S, Armour M, Reid R, Smith C. Chronic pelvic pain: Chinese medicine practitioner's knowledge, treatment strategies and integration of practice. Advances in Integrative Medicine 2019. [DOI: 10.1016/j.aimed.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hunter J, Liu J, Lee MS, Arentz S. Clinical practice guidelines: bridging traditional knowledge, scientific evidence and practice. Advances in Integrative Medicine 2019. [DOI: 10.1016/j.aimed.2019.03.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Arentz S, Smith CA, Abbott J, Bensoussan A. Nutritional supplements and herbal medicines for women with polycystic ovary syndrome; a systematic review and meta-analysis. BMC Complement Altern Med 2017; 17:500. [PMID: 29178904 PMCID: PMC5702141 DOI: 10.1186/s12906-017-2011-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 11/16/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common, reproductive endocrinopathy associated with serious short and long term health risks. Many women with PCOS use ingestible complementary medicines. This systematic review examined the effect on menstrual regulation and adverse effects from randomised controlled trials. METHODS Randomised controlled trials (RCTs) that compared herbal or nutritional supplements to placebo or active controls in women with PCOS were eligible for inclusion. Electronic databases were searched to July 2017. Study selection and assessment of quality were conducted independently by two review authors. RESULTS Twenty four studies (1406 women) investigating seven nutritional supplements and four herbal medicines were included. No one study was assessed as having a low risk of bias. Four trials reported on the primary endpoint menstrual regulation. There was no evidence on improved menstrual regularity for calcium plus vitamin D compared to Metformin (RR: 0.66, 95% CI 0.35 to 1.23, p = 0.19), reduced amenorrhoea for Camellia sinensis compared to placebo (RR: 0.17, 95% CI 0.02 to 1.72, p = 0.13) and no difference in the number of menses per month for Cinnamomum sp. against placebo (MD 0.05, 95% CI -0.36 to 1.36, p = 0.26). Adverse effects were investigated in seven studies (164 women). Mild adverse effects were found for Cinnamomum sp. compared to placebo (17 women, RR: 0.36, 95% CI 0.03 to 0.70, p = 0.03). No difference was found for adverse effects between inositol, B complex vitamins, vitamin D, chromium and placebo. Improved reproduction, metabolic hormones and hyperandrogenism was found for inositol and improved cholesterol for omega three fish oils. CONCLUSION There is no high quality evidence to support the effectiveness of nutritional supplements and herbal medicine for women with PCOS and evidence of safety is lacking. High quality trials of nutritional supplements and herbal medicines examining menstrual regulation and adverse effects in women with PCOS are needed.
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Affiliation(s)
- Susan Arentz
- National Institute of Complementary Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Caroline A. Smith
- National Institute of Complementary Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Jason Abbott
- School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia
| | - Alan Bensoussan
- National Institute of Complementary Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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Arentz S, Smith CA, Abbott J, Fahey P, Cheema BS, Bensoussan A. Combined Lifestyle and Herbal Medicine in Overweight Women with Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial. Phytother Res 2017; 31:1330-1340. [PMID: 28685911 PMCID: PMC5599989 DOI: 10.1002/ptr.5858] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/31/2017] [Accepted: 06/03/2017] [Indexed: 12/25/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common, complex reproductive endocrinopathy characterized by menstrual irregularities, hyperandrogenism and polycystic ovaries. Lifestyle modification is a first-line intervention; however, there are barriers to success for this form of self-care, and women often seek adjunct therapies including herbal medicines. This pragmatic, randomized controlled trial, delivered in communities of Australia in overweight women with PCOS, compared the effectiveness and safety of a lifestyle intervention plus herbal medicine against lifestyle alone. All participants were helped to construct a personalized lifestyle plan. The herbal intervention consisted of two tablets. Tablet 1 contained Cinnamomum verum, Glycyrrhiza glabra, Hypericum perforatum and Paeonia lactiflora. Tablet 2 contained Tribulus terrestris. The primary outcome was oligomenorrhoea/amenorrhoea. Secondary outcomes were hormones; anthropometry; quality of life; depression, anxiety and stress; pregnancy; birth outcomes; and safety. One hundred and twenty-two women gave their consent. At 3 months, women in the combination group recorded a reduction in oligomenorrhoea of 32.9% (95% confidence interval 23.3-42.6, p < 0.01) compared with controls, estimated as a large effect (ηp2 = 0.11). Other significant improvements were found for body mass index (p < 0.01); insulin (p = 0.02) and luteinizing hormone (p = 0.04); blood pressure (p = 0.01); quality of life (p < 0.01); depression, anxiety and stress (p < 0.01); and pregnancy rates (p = 0.01). This trial provides evidence of improved effectiveness and safety for lifestyle intervention when combined with herbal medicines in women with PCOS. © 2017 The Authors. Phytotherapy Research published by John Wiley & Sons Ltd.
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Affiliation(s)
- Susan Arentz
- National Institute of Complementary MedicineWestern Sydney UniversityBuilding 5, Campbelltown Campus, Locked Bag 1797PenrithNSW2751Australia
| | - Caroline A. Smith
- National Institute of Complementary MedicineWestern Sydney UniversityBuilding 5, Campbelltown Campus, Locked Bag 1797PenrithNSW2751Australia
| | - Jason Abbott
- School of Women's and Children's Health, Level 1, Women's Health Institute, Royal Hospital for WomenUniversity of New South WalesBarker StreetRandwickNSW2031Australia
| | - Paul Fahey
- School of Science and HealthWestern Sydney UniversityBuilding 24, Locked Bag 1797PenrithNSW2751Australia
| | - Birinder S. Cheema
- National Institute of Complementary MedicineWestern Sydney UniversityBuilding 5, Campbelltown Campus, Locked Bag 1797PenrithNSW2751Australia
- School of Science and HealthWestern Sydney UniversityBuilding 24, Locked Bag 1797PenrithNSW2751Australia
| | - Alan Bensoussan
- National Institute of Complementary MedicineWestern Sydney UniversityBuilding 5, Campbelltown Campus, Locked Bag 1797PenrithNSW2751Australia
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Arentz S, Abbott JA, Smith CA, Bensoussan A. Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; a review of the laboratory evidence for effects with corroborative clinical findings. BMC Complement Altern Med 2014; 14:511. [PMID: 25524718 PMCID: PMC4528347 DOI: 10.1186/1472-6882-14-511] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/09/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a prevalent, complex endocrine disorder characterised by polycystic ovaries, chronic anovulation and hyperandrogenism leading to symptoms of irregular menstrual cycles, hirsutism, acne and infertility. Evidence based medical management emphasises a multidisciplinary approach for PCOS, as conventional pharmaceutical treatment addresses single symptoms, may be contra-indicated, is often associated with side effects and not effective in some cases. In addition women with PCOS have expressed a strong desire for alternative treatments. This review examines the reproductive endocrine effects in PCOS for an alternative treatment, herbal medicine. The aim of this review was to identify consistent evidence from both pre-clinical and clinical research, to add to the evidence base for herbal medicine in PCOS (and associated oligo/amenorrhoea and hyperandrogenism) and to inform herbal selection in the provision clinical care for these common conditions. METHODS We undertook two searches of the scientific literature. The first search sought pre-clinical studies which explained the reproductive endocrine effects of whole herbal extracts in oligo/amenorrhoea, hyperandrogenism and PCOS. Herbal medicines from the first search informed key words for the second search. The second search sought clinical studies, which corroborated laboratory findings. Subjects included women with PCOS, menstrual irregularities and hyperandrogenism. RESULTS A total of 33 studies were included in this review. Eighteen pre-clinical studies reported mechanisms of effect and fifteen clinical studies corroborated pre-clinical findings, including eight randomised controlled trials, and 762 women with menstrual irregularities, hyperandrogenism and/or PCOS. Interventions included herbal extracts of Vitex agnus-castus, Cimicifuga racemosa, Tribulus terrestris, Glycyrrhiza spp., Paeonia lactiflora and Cinnamomum cassia. Endocrine outcomes included reduced luteinising hormone (LH), prolactin, fasting insulin and testosterone. There was evidence for the regulation of ovulation, improved metabolic hormone profile and improved fertility outcomes in PCOS. There was evidence for an equivalent effect of two herbal medicines and the pharmaceutical agents bromocriptine (and Vitex agnus-castus) and clomiphene citrate (and Cimicifuga racemosa). There was less robust evidence for the complementary combination of spirinolactone and Glycyrrhiza spp. for hyperandrogenism. CONCLUSIONS Preclinical and clinical studies provide evidence that six herbal medicines may have beneficial effects for women with oligo/amenorrhea, hyperandrogenism and PCOS. However the quantity of pre-clinical data was limited, and the quality of clinical evidence was variable. Further pre-clinical studies are needed to explain the effects of herbal medicines not included in this review with current clinical evidence but an absence of pre-clinical data.
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Affiliation(s)
- Susan Arentz
- National Institute of Complementary Medicine, University of Western, Locked Bag 1797, Penrith South, NSW, 2751, Sydney, Australia.
| | - Jason Anthony Abbott
- School of Women's and Children's Health, University of New South Wales, Sydney, Sydney, Australia.
| | - Caroline Anne Smith
- National Institute of Complementary Medicine (NICM), University of Western Sydney, Sydney, Australia.
| | - Alan Bensoussan
- National Institute of Complementary Medicine (NICM), University of Western Sydney, Sydney, Australia.
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Arentz S, Smith CA, Abbott JA, Bensoussan A. A survey of the use of complementary medicine by a self-selected community group of Australian women with polycystic ovary syndrome. Altern Ther Health Med 2014; 14:472. [PMID: 25481654 PMCID: PMC4265410 DOI: 10.1186/1472-6882-14-472] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/27/2014] [Indexed: 11/10/2022]
Abstract
Background Polycystic ovary syndrome (PCOS) is a complex reproductive endocrinopathy affecting up to 20% of reproductive aged women. Whilst there are effective pharmaceutical treatment options, women with PCOS have expressed a strong desire for alternatives. This study investigates the use and attitudes of women with PCOS towards complementary medicine (CM). Methods Women as members of PCOS support groups responded to an anonymous on-line survey which examined rates and patterns of use for CM’s, areas of health for use, perceptions of effectiveness, safety and demographic features. Data collection targeted women with PCOS using two consumer support groups. The first group self-selected following direct email to members of a land based consumer support group, the Polycystic Ovary Syndrome Association of Australia (POSAA). The second sample was generated through the electronic social network Facebook, using a snowball technique. Two surveys, identical in content, were collected by cloud based Survey Monkey. Data were described and associations between the variables, ‘reasons for use’ and ‘perceptions of effectiveness’ were explored. Non-response bias was assessed using a continuum of resistance model. Results 493 women participated in the study; 91.1% response rate from the POSAA group. Over 70% reported use of complementary medicine, usually nutritional and herbal supplements and 76.6% of CM users reported consultation with a complementary practitioner. Many participants were using CM to treat PCOS however most were using it to concurrently treat a range of health conditions, describing women’s desire for more than single symptom management. Disadvantages for CM use were cited by 71% of respondents. Women using complementary medicine with specific treatment goals in mind reported greater self-perceived effectiveness, suggesting that informed use may improve women’s satisfaction with CM. Adverse reactions were reported by 12.2% of women and the need for further research into adverse reactions for CM’s was identified. Demographic and PCOS characteristics were similar to clinical populations of PCOS and non-response bias was shown as not significant. Conclusion This study describes the prevalence of use for complementary medicine by women with PCOS as over 70% and adds to our understanding of women’s experiences with CM and their motivations for use of CM. Electronic supplementary material The online version of this article (doi:10.1186/1472-6882-14-472) contains supplementary material, which is available to authorized users.
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Abstract
OBJECTIVE Anatomic reconstruction is the treatment of choice for lateral ankle ligament instability. A similar technique has recently been described for stabilisation of a chronic unstable calcaneocuboid joint as an alternative to the previously proposed tenodesis and arthrodesis procedures. METHODS Five consecutive young females experiencing recurrent giving way of six calcaneocuboid joints were treated operatively during a 4 year period using anatomic ligament repair reinforced by a periosteal flap. Results were compared to five patients who underwent anatomic lateral ankle ligament repair in a case-control design. Outcome was measured using the Foot and Ankle Outcome Score, physical examination, and stress radiographic and MRI (calcaneocuboid group) investigation. Functional neuromuscular performance was evaluated by isokinetic torque measurements, posturometry, single-leg drop jumps, and single-leg long jumps. RESULTS Outcome scores at follow up (5-61 months after surgery) revealed excellent results for both groups. No relevant difference was found between the affected legs and the non-affected legs or between groups with respect to the outcome measures. MRI exhibited ligament-like structures at the repaired dorsal calcaneocuboid joints in five out of six joints. CONCLUSIONS Results of anatomic repair of unstable lateral ankle and isolated calcaneocuboid joint instability equally lead to excellent results.
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Affiliation(s)
- H Lohrer
- Institute of Sports Medicine, Otto-Fleck-Schneise 10, 60528 Frankfurt am Main, Germany.
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Lohrer H, Arentz S. Die Impingementläsion der distalen Achillessehne bei Bursitis subachillae und Haglund-Pseudoexostose - eine therapeutische Herausforderung. Sportverletz Sportschaden 2003; 17:181-8. [PMID: 14666435 DOI: 10.1055/s-2003-45406] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Retrocalcaneal bursitis in athletes is frequently misdiagnosed. Results of conservative treatment are not very promising. This investigation evaluates the results of 39 consecutive cases in 38 patients surgically treated due to chronic retrokalkaneal bursitis in a sport specific population. Preoperative MRI and ultrasound investigation showed corresponding lesions (focal degeneration, partial rupture) of the anterior Achilles tendon. This is possibly the result of a previously undescribed impingement lesion produced by the Haglund's bone and the chronically inflamed retrocalcaneal bursa. During operation this lesion was additionally addressed in 85% of the cases. Follow up was done after 32 months. Success rate was 54%. VISA-A Score at follow up was 80.6 points. Training and competition activities were started at 16 weeks and 9 months respectively. Unsatisfying results were analysed. In two cases Haglund's bone resection was incomplete and had to be removed in a reoperation. Additionally one deep wound infection had to be revised. Due to the distal Achilles tendon fiber extensions around the medial and lateral calcaneal bone, an unintended Achilles tendon lesion, induced by the edge of the osteotome seems to be possible. Two calcanear stress fractures complicated the postoperative rehabilitation.
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Affiliation(s)
- H Lohrer
- Sportmedizinisches Institut, Frankfurt am Main
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Lohrer H, Schöll J, Arentz S. [Achilles tendinopathy and patellar tendinopathy. Results of radial shockwave therapy in patients with unsuccessfully treated tendinoses]. Sportverletz Sportschaden 2002; 16:108-14. [PMID: 12382183 DOI: 10.1055/s-2002-34752] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- H Lohrer
- Orthopädische Abteilung im Sportmedizinischen Institut Frankfurt/Main, Germany.
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Abstract
A gymnast is prone to catch specific acute and overload injuries as well. Those injuries are concentrated at the spine due to the fact, that high load is administered to the growing apophyseal elements. Preventive X-ray examinations are useless in this respect, because the gymnasts training starts at the age of 5-6 years and apophyseal ossification nuclei develop not before the age of about 11-13 years. On the other hand regular performed preventive clinical examinations seem to be important for preventive reasons. For this purpose we developed specific clinical tests which allow early recognition of overuse injuries while they are in a latent phase and while the athlete does not complain any pain. Furthermore staging of the injury is possible and healing response can be controlled.
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Affiliation(s)
- H Lohrer
- Orthopädische Abteilung im Sportmedizinischen Institut Frankfurt/Main.
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