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Background: The prevalence of complementary medicine use in pregnancy and lactation has been increasingly noted internationally. This systematic review aimed to determine the complementary medicine products (CMPs) used in pregnancy and/or lactation for the benefit of the mother, the pregnancy, child and/or the breastfeeding process. Additionally, it aimed to explore the resources women used, and to examine the role of maternal health literacy in this process. Methods: Seven databases were comprehensively searched to identify studies published in peer-reviewed journals (1995–2017). Relevant data were extracted and thematic analysis undertaken to identify key themes related to the review objectives. Results: A total of 4574 articles were identified; 28 qualitative studies met the inclusion criteria. Quantitative studies were removed for a separate, concurrent review. Herbal medicines were the main CMPs identified ( n = 21 papers) in the qualitative studies, with a smaller number examining vitamin and mineral supplements together with herbal medicines ( n = 3), and micronutrient supplements ( n = 3). Shared cultural knowledge and traditions, followed by women elders and health care professionals were the information sources most accessed by women when choosing to use CMPs. Women used CMPs for perceived physical, mental-emotional, spiritual and cultural benefits for their pregnancies, their own health, the health of their unborn or breastfeeding babies, and/or the breastfeeding process. Two over-arching motives were identified: 1) to protect themselves or their babies from adverse events; 2) to facilitate the normal physiological processes of pregnancy, birth and lactation. Decisions to use CMPs were made within the context of their own cultures, reflected in the locus of control regarding decision-making in pregnancy and lactation, and in the health literacy environment. Medical pluralism was very common and women navigated through and between different health care services and systems throughout their pregnancies and breastfeeding journeys. Conclusions: Pregnant and breastfeeding women use herbal medicines and micronutrient supplements for a variety of perceived benefits to their babies' and their own holistic health. Women access a range of CMP-related information sources with shared cultural knowledge and women elders the most frequently accessed sources, followed by HCPs. Culture influences maternal health literacy and thus women's health care choices including CMP use. [ABSTRACT FROM AUTHOR]

Background: The growing body of data on prevalence of complementary and alternative medicine (CAM) usage means there is a need to standardize measurement on an international level. An international team has published a questionnaire (I-CAM-Q), but no validation has yet been provided. The aim of the present study was to provide a German measurement instrument for CAM usage (I-CAM-G) which closely resembles the original English version, and to assess it's performance in two potential samples for measuring CAM usage. Methods: The English I-CAM-Q questionnaire was translated into German, and adapted slightly. The resulting I-CAM-G questionnaire was then pre-tested on 16 healthy volunteers, and 12 cognitive interviews were carried out. The questionnaire was employed in a sample of breast cancer patients (N = 92, paper and pencil), and a sample from the general population (N = 210, internet survey). Descriptive analyses of items and missing data, as well as results from the cognitive interviews, are presented in this paper. Results: The translated questionnaire had to be adapted to be consistent with the German health care system. All items were comprehensible, whereby some items were unambiguous (e.g. CAM use yes/no, helpfulness), while others gave rise to ambiguous answers (e.g. reasons for CAM use), or high rates of missing data (e.g. number of times the CAM modality had been used during the last 3 months). 78% of the breast cancer patients and up to 85% of a sample of the general population had used some form of CAM. Conclusions: Following methodologically sound and comprehensive translation, adaptation and assessment processes using recognized translation procedures, cognitive interviews, and studying the performance of the questionnaire in two samples, we arrived at a German questionnaire for measuring CAM use which is comparable with the international (English) version. The questionnaire appropriately measures CAM use, with some items being more appropriate than others. We recommend the development of a short version. [ABSTRACT FROM AUTHOR]

Background: Complementary and alternative medicine (CAM) is growing in popularity, especially within the pediatric population. Research on CAM practitioners and their specialties, such as pediatrics, is lacking. Within the chiropractic profession, pediatrics is one of the most recently established post-graduate specialty programs. This paper describes the demographic and practice characteristics of doctors of chiropractic with a pediatric diplomate. Methods: 218 chiropractors with a pediatric diplomate were invited to complete our survey using either web-based or mailed paper survey methods. Practitioner demographics, practice characteristics, treatment procedures, referral patterns, and patient characteristics were queried with a survey created with the online survey tool, SurveyMonkey©®. Results: A total of 135 chiropractors responded (62.2% response rate); they were predominantly female (74%) and white (93%). Techniques most commonly used were Diversified, Activator ®, and Thompson with the addition of cranial and extremity manipulation to their chiropractic treatments. Adjunctive therapies commonly provided to patients included recommendations for activities of daily living, corrective or therapeutic exercise, ice pack\cryotherapy, and nutritional counseling. Thirty eight percent of respondents' patients were private pay and 23% had private insurance that was not managed care. Pediatrics represented 31% of the survey respondents' patients. Chiropractors also reported 63% of their work time devoted to direct patient care. Health conditions reportedly treated within the pediatric population included back or neck pain, asthma, birth trauma, colic, constipation, ear infection, head or chest cold, and upper respiratory infections. Referrals made to or from these chiropractors were uncommon. Conclusions: This mixed mode survey identified similarities and differences between doctors of chiropractic with a pediatric diplomate to other surveys of doctors of chiropractic, CAM professionals, and pediatric healthcare providers. The pediatric diplomate certificate was established in 1993 and provides didactic education over a 2 to 3 year span. The results of this study can be used for historical information as this specialty continues to grow. [ABSTRACT FROM AUTHOR]

Background: Complementary and Alternative Medicine (CAM) is widely used throughout the UK and the Western world. CAM is commonly used for children and the decision-making process to use CAM is affected by numerous factors. Most research on CAM use lacks a theoretical framework and is largely based on bivariate statistics. The aim of this review was to identify a conceptual model which could be used to explain the decision-making process in parental choice of CAM. Methods: A systematic search of the literature was carried out. A two-stage selection process with predetermined inclusion/exclusion criteria identified studies using a theoretical framework depicting the interaction of psychological factors involved in the CAM decision process. Papers were critically appraised and findings summarised. Results: Twenty two studies using a theoretical model to predict CAM use were included in the final review; only one examined child use. Seven different models were identified. The most commonly used and successful model was Andersen's Sociobehavioural Model (SBM). Two papers proposed modifications to the SBM for CAM use. Six qualitative studies developed their own model. Conclusion: The SBM modified for CAM use, which incorporates both psychological and pragmatic determinants, was identified as the best conceptual model of CAM use. This model provides a valuable framework for future research, and could be used to explain child CAM use. An understanding of the decision making process is crucial in promoting shared decision making between healthcare practitioners and parents and could inform service delivery, guidance and policy. [ABSTRACT FROM AUTHOR]

Background: Growing popularity of complementary and alternative medicine (CAM) in the public sector is reflected in the scientific community by an increased number of research articles assessing its therapeutic effects. Some suggest that publication biases occur in mainstream medicine, and may also occur in CAM. Homeopathy is one of the most widespread and most controversial forms of CAM. The purpose of this study was to compare the representation of homeopathic clinical trials published in traditional science and CAM journals. Methods: Literature searches were performed using Medline (PubMed), AMED and Embase computer databases. Search terms included "homeo-pathy, -path, and -pathic" and "clinical" and "trial". All articles published in English over the past 10 years were included. Our search yielded 251 articles overall, of which 46 systematically examined the efficacy of homeopathic treatment. We categorized the overall results of each paper as having either "positive" or "negative" outcomes depending upon the reported effects of homeopathy. We also examined and compared 15 metaanalyses and review articles on homeopathy to ensure our collection of clinical trials was reasonably comprehensive. These articles were found by inserting the term "review" instead of "clinical" and "trial". Results: Forty-six peer-reviewed articles published in a total of 23 different journals were compared (26 in CAM journals and 20 in conventional journals). Of those in conventional journals, 69% reported negative findings compared to only 30% in CAM journals. Very few articles were found to be presented in a "negative" tone, and most were presented using "neutral" or unbiased language. Conclusion: A considerable difference exists between the number of clinical trials showing positive results published in CAM journals compared with traditional journals. We found only 30% of those articles published in CAM journals presented negative findings, whereas over twice that amount were published in traditional journals. These results suggest a publication bias against homeopathy exists in mainstream journals. Conversely, the same type of publication bias does not appear to exist between review and meta-analysis articles published in the two types of journals. [ABSTRACT FROM AUTHOR]

Background: Complementary Medicine (CM) continues to thrive across many countries. Closely related to the continuing popularity of CM has been an increased number of enrolments at CM education institutions across the public and private tertiary sectors. Despite the popularity of CM across the globe and growth in CM education/education providers, to date, there has been no critical review of peer-reviewed research examining CM education undertaken. In direct response to this important gap, this paper reports the first critical review of contemporary literature examining CM education research. Methods: A review was undertaken of research to identify empirical research papers reporting on CM education published between 2005 and 17. The search was conducted in May 2017 and included the search of PubMed and EBSCO (CINAHL, MEDLINE, AMED) for search terms embracing CM and education. Identified studies were evaluated using the STROBE, SRQP and MMAT appraisal tools. Results: From 9496 identified papers, 18 met the review inclusion criteria (English language, original empirical research data, reporting on the prevalence or nature of the education of CM practitioners), and highlighted four broad issues: CM education provision; the development of educational competencies to develop clinical skills and standards; the application of new educational theory, methods and technology in CM; and future challenges facing CM education. This critical integrative review highlights two key issues of interest and significance for CM educational institutions, CM regulators and researchers, and points to number of significant gaps in this area of research. There is very sporadic coverage of research in CM education. The clear absence of the robust and mature research regarding educational technology and e-learning taking place in medical and or allied health education research is notably absent within CM educational research. Conclusion: Despite the high levels of CM use in the community, and the thriving nature of CM educational institutions globally, the current evidence evaluating the procedures, effectiveness and outcomes of CM education remains limited on a number of fronts. There is an urgent need to establish a strategic research agenda around this important aspect of health care education with the overarching goal to ensure a well-educated and effective health care workforce. [ABSTRACT FROM AUTHOR]

Background: Bibliometric analysis is increasingly employed as a useful tool to assess the quantity and quality of research performance. The specific goal of the current study was to evaluate the performance of research output originating from Arab world and published in international Integrative and Complementary Medicine (ICM) journals. Methods: Original scientific publications and reviews from the 22 Arab countries that were published in 22 international peer-reviewed ICM journals during all previous years up to December 31st 2013, were screened using the Web of Science databases. Results: Five hundred and ninety-one documents were retrieved from 19 ICM journals. The h-index of the set of papers under study was 47. The highest h-index was 27 for Morocco, 21 for Jordan, followed by 19 for each Kingdom of Saudi Arabia (KSA), and Egypt, and the lowest h-index was 1 for each of Comoros, Qatar, and Syrian Arab Republic. No data related to ICM were published from Djibouti, and Mauritania. After adjusting for economy and population power, Somalia (89), Morocco (32.5), Egypt (31.1), Yemen (21.4), and Palestine (21.2) had the highest research productivity. The total number of citations was 9,466, with an average citation of 16 per document. The study identified 262 (44.3 %) documents with 39 countries in Arab-foreign country collaborations. Arab authors collaborated most with countries in Europe (24.2 %), followed by countries in the Asia-Pacific region (9.8 %). Conclusion: Scientific research output in the ICM field in the Arab world region is increasing. Most of publications from Arab world in ICM filed were driven by societal use of medicinal plants and herbs. Search for new therapies from available low cost medicinal plants in Arab world has motivated many researchers in academia and pharmaceutical industry. Further investigation is required to support these findings in a wider journal as well as to improve research output in the field of ICM from Arab world region by investing in more national and international collaborative research project. [ABSTRACT FROM AUTHOR]

Background: Integrative medicine (blending the best of complementary and alternative medicine (CAM) with conventional medicine) is becoming increasingly popular. Objectives: The objectives of this paper are to compare and contrast the development of two teams that set out to establish integrative medical clinics, highlighting key issues found to be common to both settings, and to identify factors that appear to be necessary for integration to occur. Methods: At St Michael's Hospital (an inner-city teaching hospital in Toronto, Canada), a total of 42 interviews were conducted between February 2004 and August 2006 wi18 key participants (4 administrators, 2 chiropractors, 2 physiotherapists and 10 family physicians). At the CARE (Complementary and Alternative Research and Education) Program at Stollery Children's Hospital, Edmonton, Canada, 44 interviews were conducted with 24 people on four occasions: June 2004, March 2005, November 2006, and June 2007. Basic content analysis was used to identify the key themes from the transcribed interviews. Results: Despite the contextual differences between the two programs, a striking number of similar themes emerged from the data. The five most important shared themes were: 1) the necessity of "champions" and institutional facilitators to conceive of, advocate for, and bring the programs to fruition; 2) the credibility of these champions and facilitators (and the credibility of the program being established) was key to the acceptance and growth of the program in each setting; 3) the ability to find the "right" practitioners and staff to establish the integrative team was crucial to each program's ultimate success; 4) the importance of trust (both the trustworthiness of the developing program as well as the trust that developed between the practitioners in the integrative team); and 5) the challenge of finding physical space to house the programs. Conclusion: The programs were ultimately successful because of the credibility of the champions, institutional facilitators and the staff members. Selection of excellent clinicians who were able to work well as a team facilitated the establishment of trust both within the team itself as well as between the team and the host institution. [ABSTRACT FROM AUTHOR]

Background: During the past years, a number of studies have demonstrated the positive effect of apple on ageing and different diseases such as cancer, degenerative and cardiovascular diseases. The unicellular yeast Saccharomyces cerevisiae represents a simple eukaryotic model to study the effects of different compounds on lifespan. We previously demonstrated that apple extracts have anti-ageing effects in this organism because of their antioxidant properties. In particular, the effect is related to the presence in this fruit of polyphenols, which give a large contribution to the antioxidant activity of apples. Methods: We we used a clonogenic assay to assess the viability and the resistance to oxidative stress of S. cerevisiae cells in the presence of Annurca apple extracts. The production of ROS and the aberrant morphology of nuclei were detected by cell staining with the fluorescent dies Dihydrorhodamine 123 and DAPI, respectively. Mitochondrial morphology was analyzed by following the localization of the mito-GFP protein into the mitochondrial matrix. Results: In this study, we show that apple extracts can increase yeast lifespan, reduce the levels of reactive oxygen species and cell sensitivity to oxidative stress, and prevent nuclei and mitochondria fragmentation protecting cells from regulated cell death. Conclusions: In this paper, by using the yeast S. cerevisiae as a model, we have demonstrated that Annurca extracts possess antioxidant properties thanks to which the extracts can reduce the intracellular ROS levels and have anti-apoptotic functions thus prolonging cell lifespan. These results contribute to knowledge on the effects of natural compounds on ageing and support the use of yeast as a model organism for the development of simple tests to assess the effectiveness of bioactive substances from natural sources. [ABSTRACT FROM AUTHOR]

Background: Communication between different health care providers (conventional and complementary) and cancer patients about their use of complementary therapies affects the health and safety of the patients. The aim of this study was to examine the qualitative research literature on the perception of and communication about the risk of complementary therapies between different health care providers and cancer patients. Methods: Systematic searches in six medical databases covering literature from 2000 to 2015 were performed. The studies were accessed according to the level of evidence and summarized into different risk situations. Qualitative content analysis was used to analyze the text data, and the codes were defined before and during the data analysis. Results: Twenty-nine papers were included in the primary analysis and five main themes were identified and discussed. The main risk situations identified were 1. Differences in treatment concepts and philosophical values among complementary and conventional health care providers. 2. Adverse effects from complementary products and herbs due to their contamination/toxicity and interactions with conventional cancer treatment. 3. Health care physicians and oncologists find it difficult to recommend many complementary modalities due to the lack of scientific evidence for their effect. 4. Lack of knowledge and information about complementary and conventional cancer treatments among different health care providers. Conclusion: The risk of consuming herbs and products containing high level of toxins is a considerable threat to patient safety (direct risk). At the same time, the lack of scientific evidence of effect for many complementary therapies and differences in treatment philosophy among complementary and conventional health care providers potentially hinder effective communication about these threats with mutual patients (indirect risk). As such, indirect risk may pose an additional risk to patients who want to combine complementary therapies with conventional treatment in cancer care. Health care providers who care for cancer patients should be aware of these risks. [ABSTRACT FROM AUTHOR]

Background: Practitioners of complementary and alternative medicine (CAM) therapies are an important and growing presence in health care systems worldwide. A central question is whether evidence-based behavior change interventions routinely employed in conventional health care could also be integrated into CAM practice to address public health priorities. Essential for successful integration are intervention approaches deemed acceptable and consistent with practice patterns and treatment approaches of different types of CAM practitioners - that is, they have context validity. Intervention development to ensure context validity was integral to Project CAM Reach (CAMR), a project examining the public health potential of tobacco cessation training for chiropractors, acupuncturists and massage therapists (CAM practitioners). This paper describes formative research conducted to achieve this goal. Methods: Intervention development, undertaken in three CAM disciplines (chiropractic, acupuncture, massage therapy), consisted of six iterative steps: 1) exploratory key informant interviews; 2) local CAM practitioner community survey; 3) existing tobacco cessation curriculum demonstration with CAM practitioners; 4) adapting/tailoring of existing curriculum; 5) external review of adaptations; 6) delivery of tailored curriculum to CAM practitioners with follow-up curriculum evaluation. Results: CAM practitioners identified barriers and facilitators to addressing tobacco use with patients/clients and saw the relevance and acceptability of the intervention content. The intervention development process was attentive to their real world intervention concerns. Extensive intervention tailoring to the context of each CAM discipline was found unnecessary. Participants and advisors from all CAM disciplines embraced training content, deeming it to have broad relevance and application across the three CAM disciplines. All findings informed the final intervention. Conclusions: The participatory and iterative formative research process yielded an intervention with context validity in real-world CAM practices as it: 1) is patient/client-centered, emphasizing the practitioner's role in a healing relationship; 2) is responsive to the different contexts of CAM practitioners' work and patient/client relationships; 3) integrates relevant best practices from US Public Health Service Clinical Practice Guidelines on treating tobacco dependence; and 4) is suited to the range of healing philosophies, scopes of practice and practice patterns found in participating CAM practitioners. The full CAMR study to evaluate the impact of the CAMR intervention on CAM practitioners' clinical behavior is underway. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are highly prevalent and associated with a large symptom burden, that is compounded in a dual HF-COPD diagnosis. Yoga has potential benefit for symptom relief; however functional impairment hinders access to usual yoga classes. We developed a Tele-Yoga intervention and evaluated it in a controlled pilot trial. This paper reports on the appropriateness and acceptability of the intervention and the evaluation design. Methods: A controlled, non-randomised trial was conducted of an 8-week Tele-Yoga intervention versus an educational control (information leaflets mailed to participants with one phone call a week). Biweekly one-hour Tele-Yoga classes were implemented via multipoint videoconferencing that connected participants to live classes via an Internet connection to their televisions. Semi-structured qualitative interviews were conducted with participants post study exit to explore reasons for and experiences of participating, including views of study outcome measures and physiological tests. Transcribed interviews were analysed using thematic content analysis. Results: Fifteen people participated in the pilot study (7 in the intervention group, 8 in the control). Of these, 12 participants were interviewed, 6 in each group, mean age 71.2 years (SD 10.09); 3 were male. Themes are reported in the following categories: acceptability and appropriateness of the intervention, potential active ingredients of the intervention, acceptability and appropriateness of the control, participation in the research, and acceptability of the testing procedures. The intervention was acceptable and appropriate: the intervention group reported enjoying yoga and valuing the home-based aspect and participants described a high symptom burden and social isolation. However, technological problems resulted in poor video-streaming quality for some participants. Potential active ingredients included physical postures, breathing exercises and guidance in relaxation and meditation. The educational control intervention was acceptable and appropriate, with participants reporting little effect on their well-being and no impact on mechanisms hypothesised to explain yoga’s effectiveness. The questionnaires and home physiological testing were acceptable to participants. Conclusions: Tele-Yoga is an acceptable and appropriate intervention in people with HF and COPD and further research is warranted to refine the technology used in its delivery. Findings provide guidance for researchers working in tele-interventions, yoga, and similar populations. Trial registration: ClinicalTrials.gov Identifier: NCT02078739 (4 March 2014). [ABSTRACT FROM AUTHOR]

Background Complementary and alternative medicine (CAM) is increasingly included within mainstream integrative healthcare (IHC) services. Health service managers are key stakeholders central to ensuring effective integrative health care services. Yet, little research has specifically investigated the role or perspective of health service managers with regards to integrative health care services under their management. In response, this paper reports findings from an exploratory study focusing exclusively on the perspectives of health service managers of integrative health care services in Australia regarding the role of CAM within their service and the health service managers rational for incorporating CAM into clinical care. Methods Health service managers from seven services were recruited using purposive and snowball sampling. Semi-structured interviews were conducted with the health service managers. The services addressed trauma and chronic conditions and comprised: five community-based programs including drug and alcohol rehabilitation, refugee mental health and women's health; and two hospital-based specialist services. The CAM practices included in the services investigated included acupuncture, naturopathy, Western herbal medicine and massage. Results Findings reveal that the health service managers in this study understand CAM to enhance the holistic capacity of their service by: filling therapeutic gaps in existing healthcare practices; by treating the whole person; and by increasing healthcare choices. Health service managers also identified CAM as addressing therapeutic gaps through the provision of a mind-body approach in psychological trauma and in chronic disease management treatment. Health service managers describe the addition of CAM in their service as enabling patients who would otherwise not be able to afford CAM to gain access to these treatments thereby increasing healthcare choices. Some health service managers expressly align the notion of treating the whole person within a health promotion model and focus on the relevance of diet and lifestyle factors as central to a CAM approach. Conclusions From the perspectives of the health service managers, these findings contribute to our understanding around the rationale to include CAM within mainstream health services that deal with psychological trauma and chronic disease. The broader implications of this study can help assist in the development of health service policy on CAM integration in mainstream healthcare services. [ABSTRACT FROM AUTHOR]

Background: Medication regimes are often poorly adhered to, and the negative consequences of this are well recognised. The dynamics underlying non-adherence are less understood. This paper examines adherence to prescription medications for mental health difficulties in relation to the use of complementary and alternative medicines (CAMs). This was based on suggestions that within medical pluralism, CAMs may reduce adherence to conventional prescription medications for reasons such as their further complicating the medication regime or their being perceived as a substitute with less adverse side effects than conventional prescription medications. Methods: Data used was from the National Comorbidity Study Replication (NCS-R), specifically those 1396 individuals who reported taking a prescription drug for mental health difficulties within the last 12 months and under the supervision of a health professional. This subsample was selected due to their being the only subgroup questioned regarding their medication adherence. Other demographic and health factors were also considered. Results: The use of complementary medicines alongside the conventional medicines bore no significant relation to odds of reporting adherence versus non adherence. Ethnicity and medication count were significant predictors of adherence versus non-adherence. Conclusions: The above findings are discussed from the point of both promoting the use of CAMs and increasing health professionals' understanding of the dynamics underlying adherence, or the lack thereof, and subsequently informing interventions to reduce the problems associated with this issue in terms of increased health care needs and reduced quality of life. [ABSTRACT FROM AUTHOR]

Background: Although there is little information available to quantify the use of complementary and alternative medicine (CAM), growing evidence suggests that CAM prevalence among patients seeking infertility treatment is increasing worldwide. There are many products available on the market and many infertile patients demand information about CAM from their health care providers. This paper investigates the prevalence of CAM use among infertile couples in Jordan. Additionally, trends and factors contributing to CAM use for infertility treatment among these couples have been evaluated. Methods: A face-to-face questionnaire inquiring demographic information, use of CAM for medical conditions, in general, and types of CAM used for infertility treatment, in specific, was completed by one thousand twenty one infertile patients attending at two types of facilities; in vitro Fertilization (IVF) centers at both public and private hospitals and infertility private clinics. Both types of facilities were distributed in different areas of Amman, the capital city of Jordan. The study was conducted between May and August 2012. Results: Our results show that CAM therapies for infertility treatment were encountered in 44.7% of the study sample. The vast majority of CAM users were females. The most commonly used CAM therapies were herbs and spiritual healing. A clear correlation between the use of CAM for infertility versus the use of CAM for other chronic medical conditions has been found. Conclusions: The prevalence of CAM use for infertility treatment in Jordan is relatively high, particularly among young females, well educated and with a low income, in consistence with the studies reported elsewhere. Herbs and spiritual healing are widely used among patients in adjunct to conventional medical interventions. As CAM use is prevalent among patients, there is a clear need for health providers to become more aware of this phenomenon and for further research in this field. [ABSTRACT FROM AUTHOR]

Background: In folk medicine, the aerial part of Crytotaenia japonica Hassk. (CJ), is applied for treatment of the common cold, cough, urinary problems, pneumonia, and skin rashes. In this paper, the in vitro and in vivo anti-inflammatory activity of CJ methanol extract was tested using lipopolysaccharide (LPS)-induced inflammatory models. Methods: We measured nitric oxide (NO), inducible NO synthase (iNOS), and inflammatory cytokine levels from LPS-stimulated mouse peritoneal macrophages. Also, several cellular signaling molecules which regulate the expressions of these inflammatory markers were examined. Finally, we tested whether oral administration of CJ methanol extract might affect the serum cytokine levels in LPS-injected mice. Results: CJ methanol extract reduced NO release via iNOS protein inhibition. The extract was also shown to decrease the secretions of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-12. Analysis of signaling molecules showed that CJ inhibited the phosphorylation of STAT1, p38, JNK and ERK1/2 as well as IκBα degradation. Finally, CJ decreased the serum levels of TNF-α and IL-6 in LPS-injected mice. Conclusions: Our results demonstrated the anti-inflammatory activity of CJ methanol extract and its possible underlying mechanisms that involve modulation of IκBα, MAPK, and STAT1 activities. [ABSTRACT FROM AUTHOR]

Background: Research has identified women in rural and remote areas as higher users of complementary and alternative medicine (CAM) practitioners than their urban counterparts. However, we currently know little about what influences women's CAM consumption across the urban/rural divide. This paper analyses 10,638 women's CAM use across urban and rural Australia. Methods: Data for this research comes from Survey 5 of the Australian Longitudinal Study on Women's Health conducted in 2007. The participants were aged 56-61years. The health status and health service use of CAM users and non-users were compared using chi-square tests for categorical variables and t-tests for continuous variables. Results: Women who consulted a CAM practitioner varied significantly by place of residence: 28%, 32% and 30% for urban, rural and remote areas respectively (P < .005). CAM users tended to be more dissatisfied with conventional care than CAM non-users, but this was consistent across the 3 areas of residence. CAM users have higher percentages of most symptoms but the only rural/urban differences were for severe tiredness, night sweats, depression and anxiety. For diagnosed diseases, CAM users have higher percentages of most diagnoses but only hypertension and skin cancer were statistically significantly higher for rural and remote but not urban women (P < .005). Conclusions: In contrast to some recent claims, our analysis suggests the lack of access to and/or patient dissatisfaction with conventional health practitioners may not play a central role in explaining higher use of CAM by women in rural and remote areas when compared to women in urban areas. [ABSTRACT FROM AUTHOR]

Background: Bach Flower Remedies are thought to help balance emotional state and are commonly recommended by practitioners for psychological problems and pain. We assessed whether Bach Flower Remedies (BFRs) are safe and efficacious for these indications by performing a systematic review of the literature. Methods: We searched MEDLINE®, Embase, AMED, and the Cochrane Library from inception until June 2008 and performed a hand-search of references from relevant key articles. For efficacy, we included all prospective studies with a control group. For safety, we also included retrospective, observational studies with more than 30 subjects. Two authors abstracted data and determined risk of bias using a recognised rating system of trial quality. Results: Four randomised controlled trials (RCTs) and two additional retrospective, observational studies were identified and included in the review. Three RCTs of BFRs for students with examination anxiety, and one RCT of BFRs for children with attention-deficit hyperactivity disorder (ADHD) showed no overall benefit in comparison to placebo. Due to the number and quality of the studies the strength of the evidence is low or very low. We did not find any controlled prospective studies regarding the efficacy of BFRs for pain. Only four of the six studies included for safety explicitly reported adverse events. Conclusion: Most of the available evidence regarding the efficacy and safety of BFRs has a high risk of bias. We conclude that, based on the reported adverse events in these six trials, BFRs are probably safe. Few controlled prospective trials of BFRs for psychological problems and pain exist. Our analysis of the four controlled trials of BFRs for examination anxiety and ADHD indicates that there is no evidence of benefit compared with a placebo intervention. [ABSTRACT FROM AUTHOR]

Background: Evidence-based practice (EBP) has become an important competency in many allied and complementary and alternative medicine (CAM) health care practitioners' professional standards of proficiency. Methods: To compliment an EBP course for allied health care professionals and CAM practitioners, we undertook a questionnaire survey to assess learning needs. We developed a questionnaire to measure allied health care professionals and CAM practitioners' basic knowledge, skills and beliefs concerning the main principles of EBP. The questionnaires were administered to all attendees of one-day EBP workshops. Results: During 2004-5 we surveyed 193 allied health care professionals and CAM practitioners who attended one-day EBP courses prior to commencement of teaching. Of the respondents 121 (62.7%) were allied health care professionals and 65 (33.7%) practitioners stated that they work in the CAM field. Our survey found that the majority of the respondents had not previously attended a literature appraisal skills workshop (87.3%) or received formal training in research methods (69.9%), epidemiology (91.2%) or statistics (80.8%). Furthermore, 67.1% of practitioners specified that they felt that they had not had adequate training in EBM and they identified that they needed more training and education in the principles of EBM (86.7%). Differences in knowledge and beliefs concerning EBP amongst allied and CAM practitioners were found and length of time since qualification was also found to be an important factor in practitioner's beliefs. More CAM practitioners compared to allied health professionals accessed educational literature via the Internet (95.3% v 68.1%, p = 0.008). Whilst, practitioners with more than 11 years experience felt that original research papers were far more confusing (p = 0.02) than their less experienced colleagues. Conclusion: The results demonstrate that practitioner's learning needs do vary according to the type of profession, time since graduation and prior research experience. Our survey findings are exploratory and will benefit from further replication, however, we do believe that they warrant consideration by allied health care and CAM tutors and trainers when planning EBP teaching curricula as it is important to tailor teaching to meet the needs of specific subgroups of trainees to ensure that specific learning needs are met. [ABSTRACT FROM AUTHOR]

Background: The use of animal products in healing is an ancient and widespread cross-cultural practice. In northeastern Brazil, especially in the semi-arid region, animals and plants are widely used in traditional medicine and play Significant roles in healing practices. Zootherapies form an integral part of these cultures, and information about animals is passed from generation to generation through oral folklore. Nevertheless, studies on medicinal animals are still scarce in northeastern Brazil, especially when compared to those focusing on medicinal plants. This paper examines the use and commercialization of animals for medicinal purposes in Brazil's semi-arid caatinga region. Methods: Data was obtained through field surveys conducted in the public markets in the city of Santa Cruz do Capibaribe, Pernambuco State, Brazil. We interviewed 16 merchants (9 men and 7 women) who provided information regarding folk remedies based on animal products. Results: A total of 37 animal species (29 families), distributed among 7 taxonomic categories were found to be used to treat 51 different ailments. The most frequently cited treatments focused on the respiratory system, and were Mainly related to problems with asthma. Zootherapeutic products are prescribed as single drugs or are mixed with other ingredients. Mixtures may include several to many more valuable medicinal animals added to other larger doses of More common medicinal animals and plants. The uses of certain medicinal animals are associated with popular local beliefs known as 'simpatias'. We identified 2 medicinal species (Struthio camelus and Nasutitermes macrocephalus) not Previously documented for Brazil. The use of animals as remedies in the area surveyed is associated with socio economic and cultural factors. Some of the medicinal animal species encountered in this study are included in lists of Endangered species. Conclusion: Our results demonstrate that a large variety of animals are used in traditional medicinal practices in Brazil's semi-arid northeastern region. In addition to the need for pharmacological investigations in order to confirm the efficiency of these folk medicines, the present study emphasizes the importance of establishing conservation priorities and sustainable production of the various medicinal animals used. The local fauna, folk culture, and monetary value of these activities are key factors influencing the use and commercialization of animal species for therapeutic purposes. [ABSTRACT FROM AUTHOR]

Background: Although the painful shoulder is one of the most common dysfunctions of the locomotor apparatus, and is frequently treated both at primary healthcare centres and by specialists, little evidence has been reported to support or refute the effectiveness of the treatments most commonly applied. According to the bibliography reviewed, physiotherapy, which is the most common action taken to alleviate this problem, has not yet been proven to be effective, because of the small size of sample groups and the lack of methodological rigor in the papers published on the subject. No reviews have been made to assess the effectiveness of acupuncture in treating this complaint, but in recent years controlled randomised studies have been made and these demonstrate an increasing use of acupuncture to treat pathologies of the soft tissues of the shoulder. In this study, we seek to evaluate the effectiveness of physiotherapy applied jointly with acupuncture, compared with physiotherapy applied with a TENS-placebo, in the treatment painful shoulder caused by subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). Methods/design: Randomised controlled multicentre study with blind evaluation by an independent observer and blind, independent analysis. A study will be made of 465 patients referred to the rehabilitation services at participating healthcare centres, belonging to the regional public health systems of Andalusia and Murcia, these patients presenting symptoms of painful shoulder and a diagnosis of subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). The patients will be randomised into two groups: 1) experimental (acupuncture + physiotherapy); 2) control (TENS-placebo + physiotherapy); the administration of rescue medication will also be allowed. The treatment period will have a duration of three weeks. The main result variable will be the change produced on Constant's Shoulder Function Assessment (SFA) Scale; as secondary variables, we will record the changes in diurnal pain intensity on a visual analogue scale (VAS), nocturnal pain intensity on the VAS, doses of non-steroid anti-inflammatory drugs (NSAIDs) taken during the study period, credibility scale for the treatment, degree of improvement perceived by the patient and degree of improvement perceived by the evaluator. A follow up examination will be made at 3, 6 and 12 months after the study period has ended. Two types of population will be considered for analysis: per protocol and per intention to treat. Discussion: The discussion will take into account the limitations of the study, together with considerations such as the choice of a simple, safe method to treat this shoulder complaint, the choice of the control group, and the blinding of the patients, evaluators and those responsible for carrying out the final analysis. [ABSTRACT FROM AUTHOR]

Background: Out-of-pocket expenditures of over $34 billion per year in the US are an apparent testament to a widely held belief that complementary and alternative medicine(CAM) therapies have benefits that outweigh their costs. However, regardless of public opinion, there is often little more than anecdotal evidence on the health and economic implications of CAM therapies. The objectives of this study are to present an overview of economic evaluation and to expand upon a previous review to examine the current scope and quality of CAM economic evaluations. Methods: The data sources used were Medline, AMED, Alt-HealthWatch, and the Complementary and Alternative Medicine Citation Index; January 1999 to October 2004. Papers that reported original data on specific CAM therapies from any form of standard economic analysis were included. Full economic evaluations were subjected to two types of quality review. The first was a 35 item checklist for reporting quality, and the second was a set of four criteria for study quality (randomization, prospective collection of economic data, comparison to usual care, and no blinding). Results: A total of 56 economic evaluations (39 full evaluations) of CAM were found covering a range of therapies applied to a variety of conditions. The reporting quality of the full evaluations was poor for certain items, but was comparable to the quality found by systematic reviews of economic evaluations in conventional medicine. Regarding study quality, 14 (36%) studies were found to meet all four criteria. These exemplary studies indicate CAM therapies that may be considered cost-effective compared to usual care for various conditions: acupuncture for migraine, manual therapy for neck pain, spa therapy for Parkinson's, self-administered stress management for cancer patients undergoing chemotherapy, pre- and post-operative oral nutritional supplementation for lower gastrointestinal tract surgery, biofeedback for patients with "functional" disorders (eg, irritable bowel syndrome), and guided imagery, relaxation therapy, and potassiumrich diet for cardiac patients. Conclusion: Whereas the number and quality of economic evaluations of CAM have increased in recent years and more CAM therapies have been shown to be of good value, the majority of CAM therapies still remain to be evaluated. [ABSTRACT FROM AUTHOR]

Background: Weight gain is common after breast cancer (BC) treatment and may increase the risk of disease recurrence. Complementary medicine (CM) use is high amongst BC patients. This paper describes the use of CM from a cross-sectional self-administered survey on prevalence and management of weight after BC. Methods: Use of CM was assessed using a question modified from the I-CAM Questionnaire. Participants were asked to rate perceived effectiveness, advantages and disadvantages, and which CM they were willing to use for weight management if there was evidence for effectiveness. The survey was emailed to members of the Breast Cancer Network Australia Survey and Review Group, the largest consumer advocacy group in Australia for people with breast cancer. Results: There were a total of 309 responses. Three quarters had used CM in the past 12 months. One third had tried CM for weight loss. Yoga, meditation and pilates were perceived to be effective for weight loss. Perceived advantages of CMs for weight loss were the ability to improve general wellbeing, relaxation, and being non-pharmacological while disadvantages were financial cost, finding a reliable practitioner, and lack of research for effectiveness. Three quarters would be willing to try CM for weight loss if there was evidence for effectiveness, with the most popular CMs being acupuncture, relaxation, yoga, supplements, and meditation. Conclusions: The high use of CM in this group is consistent with previous research. Our research suggests that BC survivors would use acupuncture, meditation, supplements and yoga for weight loss if supported by scientifically-credible evidence. Research into the effectiveness of these treatments on weight loss after BC is warranted. [ABSTRACT FROM AUTHOR]

An abstract of the article "A narrative review of research on Ayurveda," by R. Manohar, S. Eranezhath, As Mahapatra and S. Manohar is presented.

Background: Research into health and health-care seeking behaviour amongst immigrant populations suggests that culturally-based behaviours change over time towards those prevalent in the host culture. Such acculturation of immigrant groups occurs as part of the interaction of immigrants with mainstream culture. This study examined the acculturation of Ghanaian immigrants in Greater Toronto Area (Canada) focusing particularly on attitudes towards and usage of Ghanaian traditional medicine (TRM). Methods: The study used both quantitative and qualitative methods. Structured questionnaire interviews were conducted with a sample of Ghanaians in active collaboration with the Ghanaian-Canadian Association in the Greater Toronto Area (GTA). A total of 512 questionnaire interviews were conducted. In addition, three focus groups of nine participants each were conducted with a sub-sample of Ghanaians in Canada. Results: Both the questionnaire and the focus groups indicated that nearly 73% of the Ghanaian immigrants in Canada have a positive attitude toward Ghanaian TRM. This is in comparison with less than 30% who have changed their attitude for various reasons. Some of the attraction of TRM lies in its holistic origin. Ghanaians in the GTA have been pursuing 'integration' and 'assimilation' in their acculturation in Canada. Some have given up or modified some of their attitudes and opinions toward TRM to embrace the 'modern' or 'civilized' way of living. Conclusion: There is the need for health care providers and other stakeholders to be aware of the influence of religion on African immigrants during their acculturation process. Although modernity is said to be founded on the 'ruthless undermining of tradition', there is no evidence to suggest that Ghanaian traditional religion has been undermined to such an extent that there is a major change in attitudes towards TRM. [ABSTRACT FROM AUTHOR]

Background: Diarrhoea is a major health problem for children worldwide, accounting for 5-8 million deaths each year. Arque-Ajeeb (AA) is a compound formulation of Unani medicine. It is reputed for its beneficial effects in the treatment of diarrhoea and cholera, but the claim of its efficacy is yet to be tested. Therefore the present study has been planned to investigate the real efficacy of this drug in rats. Methods: The effect of Arque-Ajeeb was investigated for antidiarrhoeal activity against charcoalinduced gut transit, serotonin-induced diarrhoea and PGE2-induced small intestine enteropooling in rats. The control, standard and test groups of experimental animals were administered with normal saline (p.o.), diphenoxylate hydrochloride (5 mg/kg, p.o.) and Arque-Ajeeb (0.07 ml and 0.14 ml/kg, p.o.) respectively except the control group of PGE2-induced small intestine enteropooling which received only 5% ethanol in normal saline (i.p.). Charcoal (10 ml/kg, p.o.) and serotonin (600 µg/kg, i.p.) were administered after 30 min, while PGE2 (100 µg/kg, p.o.) was administered immediately afterwards. The distance traveled by charcoal in small intestine was measured after 15 and 30 min of charcoal administration, diarrhoea was observed every 30-min for six hour after serotonin administration and the volume of intestinal fluid was measured after 30 min of PGE2 administration. Results: Arque-Ajeeb (0.07 ml and 0.14 ml/kg) significantly inhibited the frequency of defaecation and decreased the propulsion of charcoal meal through the gastrointestinal tract, reduced the wetness of faecal droppings in serotonin-induced diarrhoea and also reduced the PGE2-induced small intestine enteropooling. Conclusion: Arque-Ajeeb may have potential to reduce the diarrhoea in rats. Thus the drug may prove to be an alternate remedy in diarrhoea. [ABSTRACT FROM AUTHOR]

Background: Nausea and vomiting during pregnancy (NVP) affects two-thirds of pregnant women to varying degrees and over the years many modalities have been used to try to alleviate this often debilitating condition. There is a paucity of information in the literature about the use or efficacy of complementary and alternative medicine (CAM) for the treatment of this condition that affects so many women. Our primary objective was to examine the prevalence of CAM usage by women suffering from NVP. Our secondary objective was to ascertain if women had any supervision in the use of these treatments. Methods: Women who called The Motherisk NVP helpline, were asked after the counseling session to complete a questionnaire, which included demographic data as well as information about their CAM use. Results: Seventy women completed the questionnaire. 61% reported using CAM therapies, of which the three most popular were: ginger, vitamin B6 and acupressure. 21% of those who reported using CAM, had consulted CAM practitioners, 8% their physicians or pharmacists and 71% discussed the usage with family, friends and other allied health professionals. Women who did not use CAM stated they would probably use these modalities if there was more information about the safety in pregnancy. Conclusion: Pregnant women with NVP are mirroring the trend in the general population of the use of CAM. They are also using CAM therapies with little supervision from practitioners experienced in the use of these modalities. [ABSTRACT FROM AUTHOR]

Background: The use of Complementary Medicines (CMs) has significantly increased in Australia over the last decade. This study attempts to determine the extent to which complementary and alternative medicines are recorded, ceased or initiated in the acute hospital setting and investigate which health professionals have a role in this process. Methods: A cross-sectional study of inpatients was conducted at a major tertiary teaching hospital. Patient's medical records were examined to determine the rates of complementary medicine (CM) use and recording on medication charts and discharge prescriptions. Patient progress notes were audited to determine which health professionals were involved with the initiation or cessation of CMs during the inpatient stay. Results: Three hundred and forty-one patients were included for analysis of which 44.3% (n = 151) participants were recorded as utilizing a CM. Patients were admitted on a mean of 2 (±1.4[Sd]; 0–9[range]) CMs and discharged on a mean of 1.7 CMs (±1.3[Sd]; 0–5[range]). 274 individual CMs were recorded on inpatient medication reconciliation forms with multivitamins, magnesium, fish oil and cholecalciferol recorded the most frequently. One hundred and fifty-eight changes to patient CM usage were recorded during the patient hospitalisation. One hundred and seven of these changes (68%) were not accounted for in the patient progress notes. Conclusion: Patients use of CM in this hospital setting do not reflect the national estimated usage. On the occasions that CM products are included in patient records, they are subsequently deprescribed following patient examination in hospital. It is currently unclear which health professionals have a role in this deprescribing process. [ABSTRACT FROM AUTHOR]

Background: Evidence-based medicine (EBM) is being embraced by an increasing number of practitioners and advocates of complementary and alternative medicine (CAM). A significant constituency within CAM, however, appears to have substantive doubts about EBM and some are expressly hostile. Discussion: Many of the arguments raised against EBM within the CAM community are based on a caricature radically at odds with established, accepted and published principles of EBM practice. Contrary to what has sometimes been argued, EBM is not cookbook medicine that ignores individual needs. Neither does EBM mandate that only proven therapies should be used. Before EBM, decisions on health care tended to be based on tradition, power and influence. Such modes usually act to the disadvantage of marginal groups. Conclusion: By placing CAM on an equal footing with conventional medicine - what matters for both is evidence of effectiveness - EBM provides an opportunity for CAM to find an appropriate and just place in health care. [ABSTRACT FROM AUTHOR]

A correction to the article "A Systematic Review of How Homeopathy Is Represented in Conventional and CAM Peer Reviewed Journals" that was published in the June 17, 2008 is presented.

Background: As Complementary and Alternative medicine (CAM) grows in popularity, there is overt recognition for research evidence to inform clinical practice. While various strategies have been trialed to overcome the barriers to such progress, it is important to first understand the extent to which these barriers impact the conduct and application of CAM research. This study aimed to garner consensus and agreement among CAM researchers and practitioners in refining and validating a preliminary survey instrument for measuring these barriers. Methods: A three-round Delphi study was undertaken with 22 international experts of CAM research and practice. Round one gathered consensus on 30 statements listing barriers to the application and conduct of CAM research. Only rounds two and three sought consensus on revised statements. Any statement demonstrating ≥ 70% agreement on a four-point Likert scale was determined to have reached consensus. Results: Consensus and agreement was achieved for all 30 statements listing the barriers to the application and conduct of research in CAM. Additional commentary by the Delphi participants directed whether a statement had to be split into two parts or reworded. This process resulted in the generation of the "BarrierS To the Application and Conduct of rEsearch" (oBSTACLES) instrument. Conclusion: This study, the first of its kind on this topic, identified consensus and agreement on a series of evidence-informed statements to measure the barriers to the conduct and application of research in CAM. The uniqueness of the oBSTACLES instrument is its ability to measure barriers across the evidence-based continuum. [ABSTRACT FROM AUTHOR]

Background: Chinese traditional herbal medicine Fuzhengkangai (FZKA) formulation combination with gefitinib can overcome drug resistance and improve the prognosis of lung adenocarcinoma patients. However, the pharmacological and molecular mechanisms underlying the active ingredients, potential targets, and overcome drug resistance of the drug are still unclear. Therefore, it is necessary to explore the molecular mechanism of FZKA. Methods: A systems pharmacology and bioinformatics-based approach was employed to investigate the molecular pathogenesis of EGFR-TKI resistance with clinically effective herb formula. The differential gene expressions between EGFR-TKI sensitive and resistance cell lines were calculated and used to find overlap from targets as core targets. The prognosis of core targets was validated from the cancer genome atlas (TCGA) database by Cox regression. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment is applied to analysis core targets for revealing mechanism in biology. Results: The results showed that 35 active compounds of FZKA can interact with eight core targets proteins (ADRB2, BCL2, CDKN1A, HTR2C, KCNMA1, PLA2G4A, PRKCA and LYZ). The risk score of them were associated with overall survival and relapse free time (HR = 6.604, 95% CI: 2.314–18.850; HR = 5.132, 95% CI: 1.531–17.220). The pathway enrichment suggested that they involved in EGFR-TKI resistance and non-small cell lung cancer pathways, which directly affect EGFR-TKI resistance. The molecular docking showed that licochalcone a and beta-sitosterol can closely bind two targets (BCL2 and PRKCA) that involved in EGFR-TKI resistance pathway. Conclusions: This study provided a workflow for understanding mechanism of CHM for against drug resistance. [ABSTRACT FROM AUTHOR]

Background: Individuals living with and beyond a cancer diagnosis are increasingly using complementary therapies and medicines (CM) to enhance the effectiveness of cancer treatment, manage treatment-related side effects, improve quality-of-life, and promote self-efficacy. In response to the increasing use and demand for CM by cancer patients, interest in the implementation of Integrative Oncology (IO) services that provide CM alongside conventional cancer care in Australia and abroad has developed. The extent that cancer services in Australia are integrating CM is uncertain. Thus, the aim of this study was to identify IO services in Australia and explore barriers and facilitators to IO service provision. Methods: A national, cross-sectional survey of healthcare organisations was conducted in 2016. Organisations in the public and private sectors, including not-for-profit organisations that provided cancer care in hospital or community setting, were included. Results: A response rate of 93.2% was achieved (n = 275/295). Seventy-one organisations (25.8%) across all states/territories, except the Northern Territory, offered IO albeit in a limited amount by many. Most common IO services included massage, psychological-wellbeing, and movement modalities in hospital outpatient or inpatient settings. There were only a few instances where biological-based complementary medicine (CM) therapies were prescribed. Funding was often mixed, including patient contributions, philanthropy, funding by the organisation, and volunteer practitioners. Of the 204 non-IO providers, 80.9% had never provided any IO service. Overwhelmingly, the most common barrier to IO was a lack of funding, followed by uncertainty about patient demand, choice of services, and establishing such services. Less-common barriers were a lack of evidence, and support from oncologists or management. More funding, education and training, and building the evidence-base for CM were the most commonly suggested solutions. Conclusion: IO is increasingly being provided in Australia, although service provision remains limited or non-existent in many areas. Mismatches appear to exist between low IO service provision, CM evidence, and high CM use by cancer patients. Greater strategic planning and policy guidance is indicated to ensure the appropriate provision of, and equitable access to IO services for all Australian cancer survivors. [ABSTRACT FROM AUTHOR]

Background: Comorbidity of musculoskeletal (MSK) and mental health (MH) problems is common but challenging to treat using conventional approaches. Integration of conventional with complementary approaches (CAM) might help address this challenge. Integration can aim to transform biomedicine into a new health paradigm or to selectively incorporate CAM in addition to conventional care. This study explored professionals' experiences and views of CAM for comorbid patients and the potential for integration into UK primary care. Methods: We ran focus groups with GPs and CAM practitioners at three sites across England and focus groups and interviews with healthcare commissioners. Topics included experience of co-morbid MSK-MH and CAM/integration, evidence, knowledge and barriers to integration. Sampling was purposive. A framework analysis used frequency, specificity, intensity of data, and disconfirming evidence. Results: We recruited 36 CAM practitioners (4 focus groups), 20 GPs (3 focus groups) and 8 commissioners (1 focus group, 5 interviews). GPs described challenges treating MSK-MH comorbidity and agreed CAM might have a role. Exercise- or self-care-based CAMs were most acceptable to GPs. CAM practitioners were generally pro-integration. A prominent theme was different understandings of health between CAM and general practitioners, which was likely to impede integration. Another concern was that integration might fundamentally change the care provided by both professional groups. For CAM practitioners, NHS structural barriers were a major issue. For GPs, their lack of CAM knowledge and the pressures on general practice were barriers to integration, and some felt integrating CAM was beyond their capabilities. Facilitators of integration were evidence of effectiveness and cost effectiveness (particularly for CAM practitioners). Governance was the least important barrier for all groups. There was little consensus on the ideal integration model, particularly in terms of financing. Commissioners suggested CAM could be part of social prescribing. Conclusions: CAM has the potential to help the NHS in treating the burden of MSK-MH comorbidity. Given the challenges of integration, selective incorporation using traditional referral from primary care to CAM may be the most feasible model. However, cost implications would need to be addressed, possibly through models such as social prescribing or an extension of integrated personal commissioning. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance was one of serious worldwide problems confused many researchers. To solve this problem, we explored the antibacterial effect of chelerythrine, a natural compound from traditional Chinese medicine and studied its action. Methods: The contents of chelerythrine from different fractions of Toddalia asiatica (Linn) Lam (T. asiatica) were determined. The anti-bacterial activities of chelerythrine were tested by disc diffusion method (K-B method). Scanning electron microscopy (SEM), alkaline phosphatase (AKP), bacterial extracellular protein leakage and SDS-PAGE analysis were also used to investigate the antibacterial mechanism of chelerythrine. Results: Analytic results of High Performance Liquid Chromatography showed that the content of chelerythrine (1.97 mg/g) in the ethyl acetate fraction was the highest, followed by those of methanol fraction and petroleum ether fraction. The in vitro anti-bacterial mechanisms of chelerythrine from T. asiatica were assessed. Chelerythrine showed strong antibacterial activities against Gram-positive bacteria, Staphylococcus aureus (SA), Methicillin-resistant S. aureus (MRSA), and extended spectrum β-lactamase S. aureus (ESBLs-SA). The minimum inhibitory concentrations (MICs) of chelerythrine on three bacteria were all 0.156 mg/mL. Furthermore, results suggested that the primary anti-bacterial mechanism of chelerythrine may be attributed to its destruction of the channels across the bacterial cell membranes, causing protein leakage to the outside of the cell, and to its inhibition on protein biosynthesis. Images of scanning electron microscope revealed severe morphological changes in chelerythrine-treated bacteria except control, damage of parts of the cell wall and cell membrane as well as the leakage of some substances. Conclusions: Chelerythrine isolated from root of Toddalia asiatica (Linn) Lam possesses antibacterial activities through destruction of bacterial cell wall and cell membrance and inhibition of protein biosynthesis. [ABSTRACT FROM AUTHOR]

Background: Biologically-based complementary medicines (BB-CAM) including herbs and nutritional supplements are frequently taken by breast- and gynecological cancer patients undergoing systemic therapy. The aim of this study was to analyze the use of these natural CAM methods under systemic therapy. Methods: From September 2014 to December 2014 and February 2017 to May 2017 all patients (n= 717) undergoing systemic therapy at the day care unit, Department of Gynecology and Obstetrics, Technical University Munich, Germany, with breast- and/or gynecological cancer were included in this survey. The self-administered 8-item questionnaire was developed to obtain information on complementary medication intake during systemic therapy. Results: Among 448 respondents 74.1% reported to use complementary medication simultaneous to their systemic therapy. The most frequently applied methods during therapy were vitamins and minerals supplements (72.3%), medicinal teas (46.7%), phytotherapy (30.1%), and mistletoe (25.3%). The analysis showed that various patients-, disease- and therapy characteristics like receiving chemotherapy (p= 0.002), and younger age (younger than 60 years; p=0.017) are significantly associated with BB-CAM use. Conclusions: Our data suggest that female cancer patients undergoing systemic therapy frequently use BB-CAM medicine. Therefore, it is indispensable to implement counseling and evidence-based complementary treatments into clinical routine of cancer centers. A counseling service for integrative medicine concepts and an outpatient program (ZIGG) was therefore implemented in our cancer center in 2013. Further research on the CAM intake of cancer patients is needed in order to verify drug interactions and implement specific guidelines for integrative medication concepts. [ABSTRACT FROM AUTHOR]

Background: Alcohol is consumed almost worldwide and is the most widely used recreational drug in the world. Harmful use of alcohol is known to cause a large disease-, social- and economic burden on society. Only a few studies have examined the relationship between CAM use and alcohol consumption. To our knowledge there has been no such research in Norway. The aim of this study is to describe and compare alcohol consumption and injuries related to alcohol across gender and different CAM approaches. Methods: The data used in this study is based on questionnaire data gathered from the sixth Tromsø Study conducted between 2007 and 2008. Information on CAM use and alcohol consumption was available for 6819 women and 5994 men, 64.8% of the invited individuals. Pearson chi-square tests and independent sample t-tests were used to describe the basic characteristics of the participants and to calculate the differences between men and women regarding these variables. Binary logistic regression analyses were used to investigate the associations between the different CAM approaches and alcohol consumptions and injuries caused by drinking. Results: Women who drank alcohol more than once a month were more likely to have applied herbal or “natural” medicine and self-treatment techniques (meditation, yoga, qi gong or tai-chi), compared to those who never drank, and those who only drank monthly or less. For women, an association was also found between having experienced injuries caused by drinking and use of self-treatment techniques and visit to a CAM practitioner. No association was found between amount of alcohol consumed and use of CAM approaches. For men, an association was found between injuries caused by drinking and use of herbal or “natural” medicine. Conclusion: The findings from this cross-sectional study suggests that women who drink frequently are more likely to use “natural” medicine and self-treatment techniques. Both men and women who had experienced injuries because of their drinking were more likely to have used CAM approaches. [ABSTRACT FROM AUTHOR]

Background: In Korea, there are two types of medical doctors: one practises conventional medicine (hereafter called a physician), and the other practises traditional medicine (hereafter called a Korean medical doctor). This study aimed to compare the provision of complementary and alternative medicine (CAM) by these providers to CAM use per self-judgement in Korea. Methods: We analysed 1668 Korean people via an internet survey with the Korean adopted version of the I-CAM-Q, namely, the International Questionnaire to measure use of CAM, to understand whether respondents used CAM based either on a prescription or advice from a physician or a Korean medical doctor or on self-judgement. Results: In the previous 12 months, the proportions of respondents who were treated by a physician, who were treated by a Korean medical doctor and who were not treated by anyone were 67.9, 20.7 and 14.2%, respectively. Among the respondents who received CAM based on a prescription or advice from a physician, traditional Korean medicine practices and dietary supplements were commonly used; only a small percentage used other CAM therapies. Respondents who received CAM based on a prescription or advice from a Korean medical doctor showed similar results. Acupuncture and moxibustion, traditional Korean medicines (decoction), or cupping were more commonly used. Korean traditional medicines as over-the-counter (OTC) drugs were more commonly used by respondents who received CAM therapy based on a prescription or advice from a physician than by those who received CAM therapy based on a prescription or advice from a Korean medical doctor. A total of 74% of the responders used any CAM by self-judgement in the previous 12 months. Conclusions: For the use of CAM in Korea, in addition to the Korean traditional medical care provided by Korean medical doctors, general physicians advised people regarding Korean traditional medical care and dietary supplements. [ABSTRACT FROM AUTHOR]

Background: Complementary and alternative medicines (CAM) are sometimes used by individuals who desire to improve the outcomes of their fertility treatment and/or mental health during fertility treatment. However, there is little comprehensive information available that analyzes various CAM methods across treatment outcomes and includes information that is published in languages other than English. Method: This scoping review examines the evidence for 12 different CAM methods used to improve female and male fertility outcomes as well as their association with improving mental health outcomes during fertility treatment. Using predefined key words, online medical databases were searched for articles (n = 270). After exclusion criteria were applied, 148 articles were analyzed in terms of their level of evidence and the potential for methodological and author bias. Results: Surveying the literature on a range of techniques, this scoping review finds a lack of high quality evidence that complementary and alternative medicine (CAM) improves fertility or mental health outcomes for men or women. Acupuncture has the highest level of evidence for its use in improving male and female fertility outcomes although this evidence is inconclusive. Conclusion: Overall, the quality of the evidence across CAM methods was poor not only because of the use of research designs that do not yield conclusive results, but also because results were contradictory. There is a need for more research using strong methods such as randomized controlled trials to determine the effectiveness of CAM in relation to fertility treatment, and to help physicians and patients make evidence-based decisions about CAM use during fertility treatment. [ABSTRACT FROM AUTHOR]

Background: Many complementary therapies offer benefits for patients with cancer. Others may be risky for patients due to negative interactions with conventional treatment and adverse effects. Therefore, cancer patients need guidance from health care providers to assess complementary modalities appropriately to receive benefits and avoid harm. Method: In a self-administered questionnaire-based cross-sectional study, we compared knowledge and attitudes of health care providers with no training in complementary modalities to that of health care providers with training in complementary modalities about the risks for patients who combine complementary modalities with conventional treatment in cancer care. The analysis was based on responses from 466 participants. Results: The attitudes and knowledge about direct risk followed provider specialty. Ninety-four percent of the medical doctors, 93% of the nurses, and 87% of the providers with dual training, but 70% of the complementary therapists, believed that complementary modalities can cause adverse effects (p < 0.001). The majority of the medical doctors and nurses believed that it is risky to combine complementary and conventional cancer treatments (78% and 93%, respectively), compared to 58% of the providers with dual training and 43% of the complementary therapists (p < 0.001). Eighty-nine percent of the medical doctors and nurses believed that complementary modalities should be subjected to more scientific testing before being accepted by conventional health care providers, in contrast to 56% of the dually trained and 57% of the complementary therapists (p < 0.001). The majority of the medical doctors (61%) and nurses (55%) would have neither discouraged nor encouraged the use of complementary modalities if patients asked them for advice. Moreover, less than 1% of the complementary therapists would have discouraged the use of conventional cancer treatments. The study participants believed that the most important factor to recommend a complementary cancer modality to patients is evidence for safety. Conclusion: The health care providers in this study believed that complementary modalities are associated with direct risk and can cause adverse effects, and that it is risky to combine conventional and complementary treatments due to potential harmful interactions. [ABSTRACT FROM AUTHOR]

Background: Within the intercultural milieu of medical pluralism, a nexus of worldviews espousing distinct explanatory models of illness, our research aims at exploring factors leading to complementary and alternative medicine (CAM) use with special attention to their cultural context. Methods: The results are based on medical anthropological fieldwork (participant observation and in-depth interviews) spanning a period from January 2015 to May 2017 at four clinics of Traditional Chinese Medicine in Budapest, Hungary. Participant observation involved 105 patients (males N = 42); in-depth interviews were conducted with patients (N = 9) and practitioners (N = 9). The interviews were coded with Interpretative Phenomenological Analysis; all information was aggregated employing Atlas.ti software. Results: In order to avoid the dichotomization of "push and pull factors," results obtained from the fieldwork and interviews were structured along milestones of the patient journey. These points of reference include orientation among sources of information, biomedical diagnosis, patient expectations and the physician-patient relationship, the biomedical treatment trajectory and reasons for non-adherence, philosophical congruence, and alternate routes of entry into the world of CAM. All discussed points which are a departure from the strictly western therapy, entail an underlying socio-cultural disposition and must be scrutinized in this context. Conclusions: The influence of one's culturally determined explanatory model is ubiquitous from the onset of the patient journey and exhibits a reciprocal relationship with subjective experience. Firsthand experience (or that of the Other) signifies the most reliable source of information in matters of illness and choice of therapy. Furthermore, the theme of (building and losing) trust is present throughout the patient journey, a determining factor in patient decision-making and dispositions toward both CAM and biomedicine. [ABSTRACT FROM AUTHOR]

Background: Many European citizens are seeking complementary and alternative medicine (CAM). These treatments are regulated very differently in the EU/EFTA countries. This may demonstrate differences in how risk associated with the use of CAM is perceived. Since most CAM treatments are practiced fairly similarly across Europe, differing risk understandings may influence patient safety for European CAM users. The overall aim of this article is thus to contribute to an overview and awareness of possible differing risk understandings in the field of CAM at a policymaking/structural level in Europe. Methods: The study is a re-analysis of data collected in the CAMbrella EU FP7 document and interview study on the regulation of CAM in 39 European countries. The 12 CAM modalities included in the CAMbrella study were ranked with regard to assumed risk potential depending on the number of countries limiting its practice to regulated professions. The 39 countries were ranked according to how many of the included CAM modalities they limit to be practiced by regulated professions. Results: Twelve of 39 countries generally understand the included CAM treatments to represent "high risk", 20 countries "low risk", while the remaining 7 countries understand CAM treatments as carrying "very little or no risk". The CAM modalities seen as carrying a risk high enough to warrant professional regulation in the highest number of countries are chiropractic, acupuncture, massage, homeopathy and osteopathy. The countries understanding most of the CAM modalities in the study as potentially high-risk treatments are with two exceptions (Portugal and Belgium) all concentrated in the southeastern region of Europe. Conclusion: The variation in regulation of CAM may represent a substantial lack of common risk understandings between health policymakers in Europe. We think the discrepancies in regulation are to a considerable degree also based on factors unrelated to patient risk. We argue that it is important for patient safety that policy makers across Europe address this confusing situation. This could be done by applying the WHO patient safety definitions and EU's policy to facilitate access to "safe and high-quality healthcare", and regulate CAM accordingly. [ABSTRACT FROM AUTHOR]

Background: Conventional therapy (CT) such as donepezil and memantine are well-known short-term treatments for the symptoms of Alzheimer's disease (AD). The efficacy of them, however, drops below baseline level after 9 months. In China, herbal therapy as a complementary therapy is very popular. Should conventional therapy combined with herbal therapy (CT + H) make add-on benefit? Methods: In this retrospective cohort study, 344 outpatients diagnosed as probable dementia due to AD were collected, with the treatment of either CT + H or CT alone in clinical settings. All the patients were examined with coronary MRI scan. Cognitive functions were obtained by mini-mental state examination (MMSE) every 3 months with the longest follow-up of 24 months. Results: Most of the patients were initially diagnosed with mild (MMSE = 21-26, n = 177) and moderate (MMSE = 10-20, n = 137) dementia. At 18 months, CT+ H patients scored on average 1.76 (P = 0.002) better than CT patients, and at 24 months, patients scored on average 2.52 (P < 0.001) better. At 24 months, the patients with improved cognitive function (ΔMMSE ≥ 0) in CT + H was more than CT alone (33.33% vs 7.69%, P = 0.020). Interestingly, patients with mild AD received the most robust benefit from CT + H therapy. The deterioration of the cognitive function was largely prevented at 24 months (ΔMMSE = -0.06), a significant improvement from CT along (ΔMMSE = -2.66, P = 0.005). Conclusions: Compared to CT alone, CT + H significantly benefited AD patients. A symptomatic effect of CT + H was more pronounced with time. Cognitive decline was substantially decelerated in patients with moderate severity, while the cognitive function was largely stabilized in patients with mild severity over two years. These results imply that Chinese herbal medicines may provide an alternative and additive treatment for AD. [ABSTRACT FROM AUTHOR]

Background: High prevalence of herbal medicines used in pregnancy and the lack of information on their safety is a public concern. Despite this, no significant research has been done regarding potential adverse effects of using herbal medicines during pregnancy, especially among developing Asian countries. Methods: Cross-sectional studies were searched up to year 2016 on PubMed/Medline and EMBASE, the data were extracted and quality of studies was assessed using the quality appraisal tool. The findings are reported in accordance to the PRISMA checklist (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Classification on safety of identified herbal medicines was done based on current scientific literature. Results: This study included eight cross-sectional studies (2729 participants) from seven different Asian countries, of which 1283 (47.01%) women used one or more herbal medicines during pregnancy. Peppermint (22.8%), aniseed (14. 7%), olibanum (12.9%), flixweed seed (12.2%) and ginger (11.5%) were the most frequently used herbal medicines. Out of the 33 identified herbal medicines, 13 were classified as safe to use, five as use with caution, eight were potentially harmful to use in pregnancy and information on seven herbal medicines was not available in the current literature. Conclusions: Several herbal medicines identified in this review were classified to be potentially harmful or the information regarding safety in pregnancy was missing. It is recommended that contraindicated herbal medicines should be avoided and other herbals should be taken under supervision of a qualified health care practitioner. The classification regarding safety of herbal medicines in pregnancy can be utilized to create awareness on prevention of adverse effects. [ABSTRACT FROM AUTHOR]

Background: Hyperlipidaemia is the major risk factor contributing to the development and progression of atherosclerosis, fatty liver and cerebrovascular disease. Pleurotus eryngii (P. eryngii) is rich in biologically active components, especially polysaccharides that exhibit various biological activities, including reducing blood lipids. In the present study, three novel polysaccharide types, including exopolysaccharides (EPS), enzymatic EPS (EEPS) and acidic EPS (AEPS) were isolated, and the hypolipidaemic and hepatoprotective effects were investigated to better understand possible hypolipidaemic mechanisms and their hepatoprotective effects. Methods: The EPS was hydrolysed by snailase (dissolved in 1% acetic acid, pH = 6) and H2SO4 (1 M) to obtain EEPS and AEPS, respectively. The in vitro antioxidant activities were measured by investigating the reducing power and the scavenging effects on radicals of hydroxyl, 1,1-diphenyl-2-picrylhydrazyl (DPPH) and superoxide anion. The hyperlipidaemic mice were induced by perfusing a high-fat emulsion. In addition to the hepatic histopathology, the following biochemical analyses were performed to investigate the antioxidative effects, including the activities of alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and catalase (CAT). Triacylglycerol (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), malondialdehyde (MDA) and lipid peroxidation (LPO) levels were also measured in serum and liver homogenate. Results: Supplementation of EPS, EEPS and AEPS could significantly improve blood lipid levels (TC, TG, HDL-C, and LDL-C), hepatic lipid levels (TC and TG), hepatic enzyme activities (ALP, ALT, and AST) and antioxidant status (GSH- Px, SOD, T-AOC, MDA, and LPO). In addition, histopathological observations indicated that these polysaccharides had potential effects in attenuating hepatocyte damage. Conclusion: These results demonstrated that both EPS and its hydrolysates EEPS and AEPS might effectively reduce serum lipid levels and protect against high-fat diet-induced hyperlipidaemia, indicating that they could be used as functional foods and natural hepatoprotectants. [ABSTRACT FROM AUTHOR]

Background: Studies of the effects of electromagnetic fields (EMFs) on cartilaginous cells show a broad range of outcomes. However EMFs are not yet clinically applied as standard treatment of osteoarthritis, as EMF effects are showing varying outcomes in the literature. The aim of this study was to examine effects of EMFs (5 mT or 8 mT) on osteoarthritic (OA) and non-OA chondrocytes in order to investigate whether EMF effects are related to chondrocyte and EMF quality. Methods: Pellets of human OA and non-OA chondrocytes were exposed to a sinusoidal 15 Hz EMF produced by a solenoid. Control groups were cultivated without EMF under standard conditions for 7 days. Cultures were examined by staining, immunohistochemistry and quantitative real-time PCR for RNA corresponding to cartilage specific proteins (COL2A1, ACAN, SOX9). Results: OA chondrocytes increased the expression of COL2A1 and ACAN under 5 mT EMF compared to control. In contrast no changes in gene expression were observed in non-OA chondrocytes. OA and non-OA chondrocytes showed no significant changes in gene expression under 8 mT EMF. Conclusion: A 5 mT EMF increased the expression of cartilage specific genes in OA chondrocytes whereas in non-OA chondrocytes no changes in gene expression were observed. An 8 mT EMF however showed no effect altogether. This suggests that EMF effects are related to EMF but also to chondrocyte quality. Further studies about the clinical relevance of this effect are necessary. [ABSTRACT FROM AUTHOR]

Background: Although pharmacists are entrusted to play a role in ensuring the safe and appropriate use of all medicines, in general, the inclusion of complementary medicines (CMs) into their professional practice has not been observed. The purpose of this study was to explore the perceptions and opinions of pharmacists and 8 key stakeholder leaders regarding the barriers that hinder pharmacists from providing care related to the use of CMs by patients/consumers and to identify solutions that would support pharmacists' in extending their role in this area. Methods: Semi-structured key informant interviews were conducted with 2 practicing pharmacists, 1 pharmacy owner, 1 key representative of a pharmacist professional organization, 1 key representative of a consumer advocacy group, 1 key representative of a medical professional organization, 1 key representative from a complementary medicine practitioner professional organization, 1 leader within a pharmacy school, 2 senior staff from a regulatory authority, and 1 key representative of the complementary medicine industry in Australia. Results: A total of 9 barriers were identified in this study. Barriers including a lack of CMs knowledge, doubts about the evidence-base, a lack of research skills and access to reliable and reputable information dominated the discussions. A total of 7 solutions were proposed. Of those, the integration of CMs curricula into under-graduate and professional pharmacy education, and defining a clearer role for pharmacists' standard of practice were considered the most important. Apposing opinions about the role of naturopaths in pharmacies were identified.. Conclusion: It is anticipated that pharmacists will be required to formalise a role in ensuring the safe and appropriate use of complementary medicines to fulfil their professional and ethical responsibilities. However, pharmacists in general are not ready to take up this extended role. Individual key stakeholder groups have considered the existing barriers and have proposed solutions that are isolated measures. To facilitate further developments related to CMs and the professional practice of pharmacy, collaborative efforts between key stakeholders are needed to strategically plan and execute an extended role in a unified manner. [ABSTRACT FROM AUTHOR]

Background: SC-E1 is a novel herbal formula consisting of five oriental medicinal herbs used frequently in traditional herbal medicine for the treatment of inflammatory diseases in Korea. This study examined the effects of SC-E1 on lipopolysaccharide (LPS)-stimulated macrophages and the molecular mechanism involved. Methods: The cytotoxic effect of the SC-E1 extract was evaluated in RAW 264.7 cells by MTT assay. The effects of SC-E1 on the free radical scavenging and generation of intracellular reactive oxygen species were measured using DPPH and DCFH-DA, respectively. The effects of SC-E1 on the production of pro-inflammatory cytokines, inflammatory mediators, and related products were determined by ELISA and western blotting. The molecular mechanism and the nuclear translocation of nuclear factor-kappa B (NF-κB) and NF-E2-related factor 2 (Nrf2) were examined by western blot analysis and immunocytochemistry. Results: SC-E1 exhibited strong anti-oxidant activity and inhibited LPS-induced NO secretion as well as iNOS expression and the production of pro-inflammatory cytokines, without affecting the cell viability. SC-E1 also suppressed the LPS-induced NF-κB activation and the mitogen-activated protein kinase (MAPK) pathway. Moreover, SC-E1 induced heme oxygenase-1 (HO-1) expression via the nuclear translocation of Nrf2. The inhibitory effects of SC-E1 on the production of pro-inflammatory cytokines were abrogated by treatment with SnPP, an HO-1 inhibitor. Conclusion: These results suggest that SC-E1 exerts its anti-oxidant and anti-inflammatory effects through the inhibition of NF-κB and MAPK as well as Nrf2-mediated HO-1 induction in macrophages. These findings provide evidences for SC-E1 to be considered as a new prescription for treating inflammatory diseases. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is a serious public health problem worldwide. Mycobacterium tuberculosis (M. tuberculosis) grows as drug tolerant pellicles. Agents that inhibit biofilm formation in M. tuberculosis have the potential to reduce the disease treatment period and improve the quality of tuberculosis chemotherapy. Parinari curatellifolia (P. curatellifolia) leaf extracts are claimed to treat symptoms similar to tuberculosis in ethnomedicinal practices. Mycobacterium smegmatis (M. smegmatis) is a surrogate organism used in antimycobacterial drug discovery assays. In this study, the effect of the leaf extracts of P. curatellifolia on M. smegmatis growth and biofilm formation was investigated in order to determine the basis of its use in traditional medicinal use. Methods: Phytochemicals from P. curatellifolia leaves were prepared using a mixture of 50% dichloromethane (DCM): 50% methanol and by serial exhaustive extraction using different solvents of decreasing polarity. The solvents were used in the following order, hexane > dichloromethane > ethyl acetate > acetone >ethanol > methanol > water. The micro-broth dilution method was used as an antimycobacterial susceptibility test to screen for the extract that effectively inhibited M. smegmatis growth and biofilm formation. Biofilm quantification was performed by staining the biofilms with crystal violet and determining the amount of the stain using a spectrophotometer. In addition, the effects of combining the most active extract with kanamycin were also investigated. Results: The minimum inhibitory concentrations (MIC) of the extracts were found to be 6.2 µg/ml for the acetone extract, 12.5 µg/ml for both the ethanol and the total extract and 50 µg/ml for both the methanol and ethyl acetate extracts. The ethanol extract, dichloromethane extract and water extract were the only extracts that effectively inhibited biofilm formation in M. smegmatis. Combining the ethanol extract with kanamycin enhanced the effect of the ethanol extract in terms of inhibition of biofilm formation. Conclusions: P. curatellifolia leaves contain phytochemicals that have the potential to be used both as antimycobacterial and anti-biofilm formation compounds. [ABSTRACT FROM AUTHOR]

Background: Since long, natural sources have been explored for possible managements of various diseases. In this context, the study is designed to evaluate Isodon rugosus Wall. ex Benth for biological potentials including antibacterial, anthelmintic, insecticidal, anti-termites and anti-Pharaoh activities followed by GC-MS analysis of active fraction to identify various bioactive compounds. Methods: I. rugosus was investigated against eight bacterial strains using well diffusion method and microdilution method with ceftriaxone as positive control. Similarly, the insecticidal activity was carried out against Tribolium castaneum, Rhyzopertha dominica, Monomorium pharaonis and Heterotermis indicola following contact toxicity method. Likewise, anthelmintic activity was performed against Ascaridia galli and Pherethima posthuma using albendazole as positive control, in which the paralysis and death times of the worms were observed. The GC-MS analysis of the most active solvent fraction was performed for identifications of various bioactive compounds. Results: Among the tested samples of I. rugosus, flavonoids and ethyl acetate fraction exhibited high antibacterial activities. The crude saponins showed highest anthelmintic activity against Pherethima posthuma and Ascaridia galli with death times of 27.67 and 29.22 min respectively at concentrations of 40 mg/ml. In insecticidal activity, chloroform fraction and saponins exhibited notable results against R. dominica (60 and 70%) and T. castaneum (70 and 76%) at concentration of 200 mg/ml. In anti-termite assay, all the plant samples showed overwhelming results, i.e. all the 25 termites were killed on the 3rd day. Similarly, in anti-Pharaoh activity, the chloroform, ethyl acetate and saponins fractions were most potent, each exhibiting LD50 of <0.1 mg/ml. In GC-MS analysis, total of 57 compounds were identified. Some of the bioactive compounds identified in GC-MS analysis are palmitic acid, hinokiol, α-amyrin, phytol, ethyl linolate, cyclohexanone, hinokione, methyl palmitate, ethyl palmitate and stigmasterol acetate. Conclusions: Based on our current results, it can be concluded that I. rugosus possess strong antibacterial, insecticidal and anthelmintic potentials having crude saponins and ethyl acetate as the most active fractions. The GC-MS analysis and biological assays reveal that ethyl acetate fraction is a suitable target for the isolation of diverse array of bioactive compounds. [ABSTRACT FROM AUTHOR]