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İdeal beslenme hamileliğin tüm evrelerinde çok önemlidir. Bununla birlikte, tüketilen tüm yaygın gıdalar, bitkisel ürünler, tamamlayıcı ve alternatif tıp (TAT) ve besleyici değeri olmayan maddelerin güvenilirliği tartışılabilir. Bitkiler her ne kadar doğal olsalar da, hamilelik sırasında tüm bitkilerin tüketimi güvenli olmayabilir. Zencefil ve nane gibi bitkiler, hamilelik döneminde en sık dört ile altıncı haftaları arasında görülen gebelik kusma ve bulantıları için güçlü, güvenli ve etkili tedavi olarak tanımlanırlar. Preeklampsi ve yüksek tansiyon önemli gebelik komplikasyonlar arasında yer alır. Hamile kadınlarda çay içmek preeklampsi riskini artırabilirken, sarımsak tüketimi ile yüksek tansiyon düşürülebilir. Hamilelik sürecinde kan şekeri seviyesi ve glikojen depolanması en az kan basıncı kadar önem taşımaktadır. Zerdeçal, kan şekeri seviyesini düzenleyip kontrol ederken kırmızı biber vücutta glikojenin depolanmasını artırır. Sitokrom P450 sistemi ile etkileşim, birçok gıda-ilaç etkileşimine yol açar. Bu sistemi etkileyen ve yaygın olarak kullanılan bitkilerden biri olan sarı kantaronun hamilelik döneminde dikkatli alınması gerekir. Hamilelik döneminde tüketiminde ihtiyatlı olunması gereken bir diğer bitki de papatyadır. Papatya yan etkileri sebebiyle pıhtılaşma bozukluğu olan bireyler tarafından dikkatli tüketilmelidir. Rezene emzirme döneminde güvenli bir bitki olarak tanımlansa da, hamilelikte bilinçli ve akıllıca kullanılmalıdır. Rezene östrojen benzeri özellikler içerdiğinden, hamilelik döneminde fetal gelişimi ve doğum ağırlığını etkileybilir. Bitkisel ürünler değişken ve belirsiz etkiler gösterebildiği için çeşni, tatlandırıcı veya içecekler olarak dikkatli tüketilmelidir., Ideal nutrition for all stages of pregnancy is so important, and the safety of consuming common foods, herbal products, complementary and alternative medicine (CAM), and nonnutritive substances is questionable. Despite the fact that herbs are entirely natural, not all of them are safe to ingest during pregnancy. Herbs such as ginger and peppermint are well known for being a powerful, safe, and effective remedy for vomiting and nausea during pregnancy. Pre-eclampsia and high blood pressure are among the important complications during pregnancy. Pre-eclampsia could be increased by drinking tea, while high blood pressure could be decreased with garlic consumption in pregnant women. During pregnancy blood glucose levels and glycogen storage are as important as blood pressure. Turmeric controls blood glucose levels, meanwhile red pepper enhances glycogen storage. Interacting with the cytochrome P450 system causes many food-drug interactions. St. John’s Wort is one of the commonly used herbs that affects this system and should be taken cautiously in pregnancy. Chamomile should be consumed cautiously as well due to its effects on individuals suffering from coagulation disorders. As a safe herb during breastfeeding, fennel should be consumed wisely in pregnancy. Fennel contains estrogen-like features that affect fetal development and birth weight. As herbal products have varying and ambiguous effects, they should be consumed (as condiments, flavoring in foods or beverages) prudently.

This study examines complementary and alternative medicine (CAM) providers’ practices in the treatment of their breast cancer survivor (BCS) clients and interprets these practices within the context of existing neuroscientific research on the mirror neuron system (MNS). Purposive and snowball sampling was conducted to recruit CAM providers (N = 15) treating BCSs from integrative medicine centers, educational institutions, private practices, and professional medical associations across the United States. In-depth semi-structured interviewing (N = 252 single-spaced pages) and inductive qualitative content analysis reveal CAM therapeutic practices emphasize a diachronic form of mimetic self-reflexivity and a serendipitous form of mimetic intersubjectivity in BCS pain management to allow the providers to tune-in to their clients’ internal states over time and experience themselves as an embodied subject in an imaginative, shared space. By employing imagination and an intentional vulnerability in their embodied simulation of the others’ internal states, CAM providers co-create experiences of pain while recognizing what about the other remains an unknown. Although MNs provide the mechanism for imitation and simulation underlying empathy through a neuronally wired grasp of the other’s intentionality, the study suggests that examining mimetic self-reflexivity and intersubjectivity in the therapeutic space may allow for a shared simulation of participants’ subjective experiences of pain and potentially inform research on self-recognition and self-other discrimination as an index of self-awareness which implicates the MNS in embodied social cognition in imaginative ways.

Background Herbal medicine administration in conventional health care services is gaining popularity lately. Much has not been documented on the perceived enhancers and challenges to herbal medicine administration at the hospital. The study sought to explore the facilitators and barriers to the clinical administration of herbal medicine in Ghana. Method Qualitative descriptive exploratory design was employed. Fourteen participants among the consented and purposively sampled nurses were interviewed. Data was transcribed and analysed using content analysis. Results The participants disclosed that facilitators to the clinical administration of herbal medicine include doctors’ prescription, affordability of herbal medications by patients, patients’ willingness to use herbal medicine and availability of herbal medicine. Barriers to the clinical administration of herbal medicine were inadequate knowledge on herbal medicine, lack of publicity, unclear integration, lack of collaboration and policies on herbal medicine administration at the hospital. Other barriers were negative mindset of patients and lack of national health insurance scheme (NHIS) coverage. Conclusion Clinical administration of herbal medicine is faced with an array of challenges. Doctor’s prescription, nursing education on herbal medicine and NHIS coverage of herbal medicine are imperative to improve herbal medicine administration in hospitals. Plain English summary Herbal medicine addition into mainstream health care services is surging high in many countries. This study aimed at finding out what nurses consider as the issues that make it easy or difficult to serve herbal medicine in the hospital. Qualitative method was employed, in-depth face-to-face interviews were conducted and data collected was typed verbatim. The typed data was content analysed and findings supported with the nurses’ statements. The findings of the study showed that facilitators to the clinical use of herbal medicine include doctors’ prescription, affordability of the herbal drug, patient’s willingness to use the herbal medication, patient’s belief about herbal medicine and availability of herbal medicine. Challenges to the clinical use of herbal medicine disclosed were lack of knowledge on herbal medicine, lack of publicity, unclear integration, lack of collaboration between health professionals and herbal medicine providers. Other barriers include negative mindset of patients and lack of national health insurance (NHIS) coverage. The researchers came to a consensus that nurses need further training on herbal medicine to enhance herbal medicine use at the hospital. Health professionals need to collaborate with herbal medicine service providers and NHIS must be reviewed to cover herbal medications.

This cross-sectional study investigated the correlation between parents’ perception and their children’s traditional Korean medicine (TKM) use reported by parents in order to discover policy intervention points and provide a reference for establishing generalized TKM policies. Participant data from a 2017 national survey on TKM usage was divided into two groups based on the children’s TKM use reported by parents. The female participants’ children had a higher rate of experience in using TKM (8.1%, p = 0.029). Additionally, 91.4% of the parent group with a child who used TKM turned out to have used TKM, which was higher than 71.9% of the parents whose children never used TKM (p &lt, 0.001). As for the awareness on the use of TKM, 44.0% of the parents with a child who experienced TKM answered they were aware of it, while only 35.3% of the parent group whose child never experienced TKM did so (p = 0.033). The present study suggests that parental experience in using TKM could have an impact on the children’s TKM use reported by parents. Further study is necessary to assess which parental factor (awareness level, medical disorder to be treated, therapy, therapeutic efficacy, the purpose of visit, sex, age, etc.) has a close relationship with TKM usage experience of their children.

Since the edifice of conventional medicine is built on the pillars of past achievements, review or re-investigate the old medical manuscripts may lead to significant achievements. Avicenna was a famous Persian medieval physician and one of the pioneers of neuroscience. The aim of this study is to evaluate Avicenna's approach to traumatic brain injury (TBI), based on his main book on medicine, “Canon of Medicine”. Avicenna divided the TBI treatments into three categories: topical therapies, oral therapies, such as diets and medications, and manipulation therapies including phlebotomy, enema, foot bath, cupping, and massage. Although some of these recommendations are supported by current knowledge, many of them are still unknown and need scientific investigation to expand our knowledge of TBI treatments in the medieval period.

Diet and nutrition play an important and essential role in everyone's life. It helps build a healthy body and a strong mind. We know that food rich in nutrients can remove toxins from the body, make an excellent immune system, curb hunger, and prevent obesity. Obesity is one of the most concerning, alarming, and fastest-growing pandemics. It affects not only adults but also adolescents and children. The disease's early-onset calls for prompt attention to control the physical, psychological, financial, and social burden it creates. Children with autism and autism spectrum disorders (ASDs) are commonly affected by eating disorders. Their preference for energy-dense food with low nutrition can alter their metabolism, leading to the accumulation of oxidative radicals, causing them to deteriorate mentally and physically. Although dieting and losing weight are now commonly seen in the general population, it has become hard to bring awareness to children with special needs about diet, nutrition, and obesity. Despite efforts, parents of such children usually cannot help control the eating because tantrums and behavioral problems are common. It is now imperative for doctors and parents to work alongside nutritionists and dieticians to help these children eat healthy to be fit and improve the quality of life.

Background The demand for complementary and integrative health (CIH) is increasing by patients who want to receive more CIH referrals, in-clinic services, and overall care delivery. To promote CIH within the context of primary care, it is critical that providers have sufficient knowledge of CIH, access to CIH-trained providers for referral purposes, and are comfortable either providing services or co-managing patients who favor a CIH approach to their healthcare. Objective The main objective was to gather primary care providers’ perspectives across the northwestern region of the United States on their CIH familiarity and knowledge, clinic barriers and opportunities, and education and training needs. Methods We conducted an online, quantitative survey through an email invitation to all primary care providers (n = 483) at 11 primary care organizations from the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region Practice and Research Network (WPRN). The survey questions covered talking about CIH with patients, co-managing care with CIH providers, familiarity with and training in CIH modalities, clinic barriers to CIH integration, and interest in learning more about CIH modalities. Results 218 primary care providers completed the survey (45% response rate). Familiarity with individual CIH methods ranged from 73% (chiropracty) to 8% (curanderismo). Most respondents discussed CIH with their patients (88%), and many thought that their patients could benefit from CIH (41%). The majority (89%) were willing to co-manage a patient with a CIH provider. Approximately one-third of respondents had some expertise in at least one CIH modality. Over 78% were interested in learning more about the safety and efficacy of at least one CIH modality. Conclusion Primary care providers in the Northwestern United States are generally familiar with CIH modalities, are interested in referring and co-managing care with CIH providers, and would like to have more learning opportunities to increase knowledge of CIH.

Background: The Norwegian authorities decided in March 2020 to implement a nationwide lockdown to prevent spread of the COVID-19 virus. The lockdown had vast socioeconomic consequences for the society. The aim of this study was to investigate how COVID-19 affected Complementary and Alternative Medicine (CAM) providers' practice, financial situation, recommendations to patients, and how they perceived their future practice as CAM providers. Method: Data were collected in this cross-sectional survey using a self-administrated electronic questionnaire. A total of 581 CAM providers completed the questionnaire, which was designed to describe consequences for CAM providers and their clinical practice caused by the nationwide lockdown. Descriptive statistics were carried out using frequency analyses to describe the demographics and consequences of the lockdown. Between group differences (gender and age) were analyzed using Pearson chi-square tests and Fisher's exact tests for categorical variables, and ANOVA tests and t-tests for continuous variables. Significance level was defined as p < 0.05 without adjustment for multiple comparisons. Result: During the nationwide lockdown of Norway, 38.4% of the respondents were able to provide CAM treatment to their patients. Of those, the majority (96.4%) had reorganized their clinical practice in accordance with COVID-19 hygiene regulations, offered video consultations (57.4%) or telephone consultations (46.6%). To manage financially during the lockdown, half of the providers spent their savings (48.7%). More than one third (35.1%) was supported by their partner, and 26.7% received compensation from the Norwegian state. A total of 26.3% of the CAM providers had other paid work that provided them with income. Nearly a fifth (18.6%) borrowed money from friends and family, changed their loan terms, or took out new bank loans. More than half (62.7%) expressed uncertainty about the future of their practice. CAM providers who had reorganized their practice to online consultations were more optimistic. Conclusion: The impact of COVID-19 on CAM providers was considerable. It adversely affected their clinical practice, financial situation, and view on their future practice. To ensure that the health needs of the Norwegian population regarding CAM use are met during pandemic times like COVID-19, it is recommended to support and train CAM providers in the development of online CAM services, as well as efficient implementation of infection prevention and control measures.

Introduction: This case study applied the Dahn Taekwondo Spondylitis Improvement Program (DTSIP) to a 30-year-old male with ankylosing spondylitis five times a week for 28 weeks. Materials and Methods: A 32-year-old male with ankylosing spondylitis underwent the Dahn Taekwondo Spondylitis Improvement Program (DTSIP), an amalgamated program of standard Western medicine practices and complementary and alternative medicine (CAM) exercises based in the oriental medicine practices of yoga and taekwondo. The subject performed the DTSIP 5 times a week for 90 minutes for 28 weeks. Results: First, blood C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and platelet levels decreased by approximately 29-71%. Second, blood leukocyte counts decreased by about 11%. Third, as a result of Bath Ankylosing Spondylitis Metrology Index (BASMI) measurement, tragus to wall (TWD), lumbar side flexion (LSF), LF (lumbar flexion), and intermalleolar distance (IMD) were improved substantially. The students’ cervical vertebrae and thoracic and lumbar vertebrae ranges of motion were additionally improved. The range of motion of the shoulder and hip joint improved. Conclusions: Therefore, the DTSIP seems to have a positive effect on the inflammation, immune functions, and spine and joint range of motion in the subject of this case study. Future studies are required with a wider sample population to validate these results.

Introduction Although there have been several national survey studies on complementary and alternative medicine (CAM) use in Japan, previous studies have not been compared with investigations conducted in other countries. An international CAM questionnaire known as I-CAM-Q was developed through a two-day international workshop in 2006. The purpose of this study was to investigate the use of CAM by the general Japanese population using a modified version of the I-CAM-Q for the Japanese (I-CAM-QJ). Methods We developed the I-CAM-QJ to conduct an internet survey of 3,208 participants from the general population of Japan in February 2016. The respondents included 1,592 males (49.6%), 1,348 university graduates (38.8%), 1,105 individuals in good health (34.4%), and 1,028 individuals with long-term illness or disability (32.0%). Results Of the 3,208 respondents, 411 participants reported CAM use during the past 12 months (12.8%). The following therapies and products were used: Kampo medicines (over-the-counter Kampo medicines: 15.7%; prescribed Kampo medicines: 15.4%), dietary supplements 11.8%, massage services 3.9%, and physical therapy 3.5%. Regarding the use of self-care methods during the last 12 months, the following methods and products were used: bath salts 25.8% and walking 25.3%. Conclusions An internet survey on CAM use by the general Japanese population with a modified I-CAM-Q (I-CAM-QJ) revealed that Kampo medicines and dietary supplements were the most commonly used CAMs in Japan.

Although the body is central to health outcomes, the provider’s body has been largely absent in the provider–patient relationship. Drawing upon semi-structured interviews with complementary and alternative medicine (CAM) providers (N = 17), this study examines how CAM providers use their body to characterize their work as healers. The findings suggest the provider’s self-reflexive awareness of their own body’s illness and faith experiences informs their understanding of the patients’ experience of health and disease. The study foregrounds the intersubjective nature of the provider–patient relationship as an embodied interaction in the mutual construction of therapeutic goals. Provider reflection on their own bodies to make sense of their patients’ experiences emphasizes provider–patient coproduction of meaning and suggests ways for including the provider’s self-reflexive awareness of their own body in a patient-centered healthcare relationship in ways that benefit both the patient and the provider.

Aims: The aim of this research was to study health-related and sociodemographic determinants of the use of different complementary and alternative medicine (CAM) treatments in Europe and differences in CAM use in various European countries. Methods: The study was based on a design-based logistic regression analysis of the European Social Survey (ESS), Round 7. We distinguished four CAM modalities: manual therapies, alternative medicinal systems, traditional Asian medical systems and mind-body therapies. Results: In total, 25.9% of the general population had used CAM during the last 12 months. Typically, only one CAM treatment had been used, and it was used more often as complementary rather than alternative treatment. The use of CAM varied greatly by country, from 10% in Hungary to almost 40% in Germany. Compared to those in good health, the use of CAM was two to fourfold greater among those with health problems. The health profiles of users of different CAM modalities varied. For example, back or neck pain was associated with all types of CAM, whereas depression was associated only with the use of mind-body therapies. Individuals with difficult to diagnose health conditions were more inclined to utilize CAM, and CAM use was more common among women and those with a higher education. Lower income was associated with the use of mind-body therapies, whereas the other three CAM modalities were associated with higher income. Conclusions: Help-seeking differed according to the health problem, something that should be acknowledged by clinical professionals to ensure safe care. The findings also point towards possible socioeconomic inequalities in health service use.

This research aimed to understand the factors attracting qualified nurses to the practice of homeopathy and the influence if any, their respective identities as nurses and homeopaths had on their nursing and homeopathic practice. Using constructivist grounded theory methodology, data was collected via semi-structured interviews with fifteen registered nurses, who were also registered homeopaths, from three states of Australia. Data from the study resulted in the development of a substantive theory, the ‘Theory of Congruent Positioning’, which proposes that the nurses in this study were attracted to the practice of homeopathy through a process of experiential and transformative learning, whereby they connected with the core tenets of homeopathic philosophy. The ‘Theory of Congruent Positioning’ also provides insights into how the respective nursing and homeopathic identities of the nurses in this study influenced their respective nursing and homeopathic practice.

In Spain, during the last decade, there has been an intense debate between advocates of complementary and alternative medicine (CAM) and a skeptical movement. Neither are these therapies integrated into the public health system nor have practitioner training courses been regulated. Notwithstanding this, their use is on the increase in Spain, as can be seen in the last public opinion survey (CIS, 2018). Thus, the objective of this work is to explore the attitudes towards and awareness and self-use of CAM among health sciences, journalism and primary teacher training students. These students were chosen since they will play a fundamental role as storytellers of evidencebased science for the foreseeable future. To perform the study, 234 students were asked to complete a Spanish version of the CAM Health Belief Questionnaire (CHBQ). The results show that, by and large, they had a positive attitude towards CAM, despite that fact that the journalism and health sciences students admitted to being wary of them to a certain extent. Four out of the five best known and most used CAM modalities among the respondents fell into the ‘mental and corporal practices’ category, i.e., yoga, massage, meditation and relaxation, This work was supported by the Spanish Ministry of Economy and Competitiveness and co-supported by ERDF funds of the European Commission, as part of the research projects “Estudio y clasificación de las terapias naturales, complementarias y alternativas a través de los medios de comunicación y de las redes sociales. Ideas y valores de transferencia al imaginario social” (CSO2014-57778-R) and “Praxeología de la cultura científica: evaluación y medición” (FFI2017-82217-C2-2-P)”.

Purpose.Breast and gynecological cancer patients undergoing systemic therapy frequently request integrative therapy concepts. The potential of integrative therapy (IM) lies in minimizing side effects of conventional cancer treatments and therefore decreasing treatment delays. IM can help to improve patients’ physical and emotional well-being, optimizing health and quality of life as IM involves patients in their own treatment. A counseling service for integrative medicine concepts as an outpatient program was implemented in our cancer center in 2013.Methods.In 2016 and 2017 144 breast and gynecological cancer patients were included into our specific IM program. The program comprises biological based complementary and alternative medicines (BB-CAM), a structured exercise therapy, manipulative and body-based practices, nutritional counseling, psycho-oncological and relaxing therapies. Therapists with additional specialization for IM, guide the treatment units. The program was evaluated via self-administered questionnaire.Results.78% of the participating patients noticed an improvement by using BB-CAMs. 86% stated to feel better through participation in the structured exercise program. 74% profited from nutritional counseling and 91% from manual therapy. 93% of the patients treated with body compresses considered the application as soothing. The Bio-Frequency Sound Color Bed led to a relaxation in 96%. Psychological therapy improved coping with the disease in 70% of the patients.Conclusion.Integrative oncology combines the best practices of conventional and complementary therapy, uniting them in a holistic concept. Data show that our integrative therapy concept is well accepted by the patients and that therapy- and disease-related side effects can be reduced.

Objective: Conventional therapeutic methods for psoriasis include topical and systemic drugs, phototherapy, and biologic agents. Despite the fact that these treatment methods, and especially biologic agents, are met with a considerable reduction in disease activity, they can sometimes be costly and are nonetheless accompanied by high risks of adverse events, ranging from mild to debilitating. Therefore, complementary and alternative medicine (CAM), especially mind-and-body interventions, such as acupuncture, psychotherapy, climatotherapy, and cupping may provide a cheaper and potentially beneficial outcome for these patients. Methods: We performed a systematic review of articles pertaining to acupuncture, cupping, psychotherapy and meditation, as well climatotherapy and balneotherapy in the management of psoriasis, by using the PubMED, Medline and Google Academic research databases and reference cross-checking. Results: 12 articles on acupuncture, 9 on dry or wet cupping, 27 concerning meditation, hypnosis or psychotherapy, and 34 regarding climate therapy or balneotherapy were found. Discussion and Conclusions: Currently, there is a lack of evidence in the English literature to support acupuncture as an effective alternative therapy for psoriasis, whereas cupping has been described in the majority of instances to result in Koebner phenomenon and clinical worsening. Stress management therapies such as psychotherapy, hypnosis, and meditation have shown promising results as complementary treatment methods. Climatotherapy and balneotherapy have already been proven as effective means of achieving clinical improvement in psoriasis. Further research is still needed to verify the usefulness of the lesser studied treatment methods.

This paper offers a short commentary on the editorial by Mannion and Exworthy. The paper highlights the positive insights offered by their analysis into the tensions between the competing institutional logics of standardization and customization in healthcare, in part manifested in the conflict between managers and professionals, and endorses the plea of the authors for further research in this field. However, the editorial is criticized for its lack of a strong societal reference point, the comparative absence of focus on hybridization, and its failure to highlight structural factors impinging on the opposing logics in a broader neo-institutional framework. With reference to the Procrustean metaphor, it is argued that greater stress should be placed on the healthcare user in future health policy. Finally, the case of complementary and alternative medicine is set out which – while not explicitly mentioned in the editorial – most effectively concretizes the tensions at the heart of this analysis of healthcare.

It appears that complementary and alternative medicine (CAM) is used increasingly often in horses for the assessment and treatment of suspected orthopaedic problems, especially back problems. The aim of this study was to determine the frequency of CAM use for the management of orthopaedic problems in a defined population of Swiss Warmblood horses. A total of 239 owners and caretakers of horses from a pre‐defined database were called by a veterinarian to participate in the survey. A standardized questionnaire was designed to determine, for each orthopaedic case, where the localization of the problem was (limb or back) and if conventional medicine or CAM was used for consultation and treatment. When CAM was employed, the CAM discipline and administrator (veterinarian or alternative therapist) was defined. A total of 222 cases in 170 horses with orthopaedic problems were identified. Sixty‐two horses were identified with a back problem, 96 horses with a lameness involving one or more limbs and 12 horses with a combined back problem and lameness. CAM was used commonly in this population (73.9%, 164 of 222) for both diagnostic workup and treatment of suspected orthopaedic problems, but was rarely administered by a veterinarian (12%, 27 of 222). In general, if a back problem was suspected by the owner, CAM was more frequently applied for diagnosis and treatment than in cases where a lameness was suspected; (91.9%, 68 of 74) vs. (64.9%, 96 of 148) (P

This paper offers a short commentary on the editorial by Mannion and Exworthy. The paper highlights the positive insights offered by their analysis into the tensions between the competing institutional logics of standardization and customization in healthcare, in part manifested in the conflict between managers and professionals, and endorses the plea of the authors for further research in this field. However, the editorial is criticized for its lack of a strong societal reference point, the comparative absence of focus on hybridization, and its failure to highlight structural factors impinging on the opposing logics in a broader neo-institutional framework. With reference to the Procrustean metaphor, it is argued that greater stress should be placed on the healthcare user in future health policy. Finally, the case of complementary and alternative medicine is set out which – while not explicitly mentioned in the editorial – most effectively concretizes the tensions at the heart of this analysis of healthcare.

Objective: Patients with small intestine bacterial overgrowth (SIBO) have chronic intestinal and extraintestinal symptomatology which adversely affects their quality of life. Present treatment of SIBO is limited to oral antibiotics with variable success. A growing number of patients are interested in using complementary and alternative therapies for their gastrointestinal health. The objective was to determine the remission rate of SIBO using either the antibiotic rifaximin or herbals in a tertiary care referral gastroenterology practice. Design: One hundred and four patients who tested positive for newly diagnosed SIBO by lactulose breath testing (LBT) were offered either rifaximin 1200 mg daily vs herbal therapy for 4 weeks with repeat LBT post-treatment. Results: Three hundred ninety-six patients underwent LBT for suspected SIBO, of which 251 (63.4%) were positive 165 underwent treatment and 104 had a follow-up LBT. Of the 37 patients who received herbal therapy, 17 (46%) had a negative follow-up LBT compared to 23/67 (34%) of rifaximin users (P=.24). The odds ratio of having a negative LBT after taking herbal therapy as compared to rifaximin was 1.85 (CI=0.77-4.41, P=.17) once adjusted for age, gender, SIBO risk factors and IBS status. Fourteen of the 44 (31.8%) rifaximin non-responders were offered herbal rescue therapy, with 8 of the 14 (57.1%) having a negative LBT after completing the rescue herbal therapy, while 10 non-responders were offered triple antibiotics with 6 responding (60%, P=.89). Adverse effects were reported among the rifaximin treated arm including 1 case of anaphylaxis, 2 cases of hives, 2 cases of diarrhea and 1 case of Clostridium difficile. Only one case of diarrhea was reported in the herbal therapy arm, which did not reach statistical significance (P=.22). Conclusion: SIBO is widely prevalent in a tertiary referral gastroenterology practice. Herbal therapies are at least as effective as rifaximin for resolution of SIBO by LBT. Herbals also appear to be as effective as triple antibiotic therapy for SIBO rescue therapy for rifaximin non-responders. Further, prospective studies are needed to validate these findings and explore additional alternative therapies in patients with refractory SIBO.

Background Patients and health care professionals are becoming increasingly preoccupied in complementary and alternative medicine (CAM) that can also be called nonpharmacological interventions (NPIs). In just a few years, this supportive care has gone from solutions aimed at improving the quality of life to solutions intended to reduce symptoms, supplement oncological treatments, and prevent recurrences. Digital social networks are a major vector for disseminating these practices that are not always disclosed to doctors by patients. An exploration of the content of exchanges on social networks by patients suffering from breast cancer can help to better identify the extent and diversity of these practices. Objective This study aimed to explore the interest of patients with breast cancer in CAM from posts published in health forums and French-language social media groups. Methods The retrospective study was based on a French database of 2 forums and 4 Facebook groups between June 3, 2006, and November 17, 2015. The extracted, anonymized, and compiled data (264,249 posts) were analyzed according to the occurrences associated with the NPI categories and NPI subcategories, their synonyms, and their related terms. Results The results showed that patients with breast cancer use mainly physical (37.6%) and nutritional (31.3%) interventions. Herbal medicine is a subcategory that was cited frequently. However, the patients did not mention digital interventions. Conclusions This exploratory study of the main French forums and discussion groups indicates a significant interest in CAM during and after treatments for breast cancer, with primarily physical and nutritional interventions complementing approved treatments. This study highlights the importance of accurate information (vs fake medicine), prescription and monitoring of these interventions, and the mediating role that health professionals must play in this regard.

IntroductionVaccine hesitancy is a complex public health issue referring to concerns about the safety, efficacy or need for vaccination. Relatively little is known about vaccine hesitancy in Switzerland. This ongoing study (2017–2021) focuses on biomedical and complementary and alternative medicine (CAM) providers and their patients since healthcare professionals play important roles in vaccination decision-making. This national research programme seeks to assess the sociocultural determinants of vaccine hesitancy regarding childhood and human papillomavirus vaccines in Switzerland. We aim to provide a detailed characterisation of vaccine hesitancy, including CAM and biomedical perspectives, patient–provider interactions, and sociocultural factors, to establish the mediating effects of vaccine hesitancy on underimmunisation, and to design an intervention to improve vaccination communication and counselling among physicians, parents and adolescents.Methods and analysisOur transdisciplinary team employs a sequential exploratory mixed-methods study design. We have established a network of more than 150 medical providers across Switzerland, including more than 40 CAM practitioners. For the qualitative component, we conduct interviews with parents, youth, and biomedical and CAM providers and observations of vaccination consultations and school vaccination information sessions. For the quantitative component, a sample of 1350 parents of young children and 722 young adults (15–26 years) and their medical providers respond to questionnaires. We measure vaccine hesitancy with the Parent Attitudes about Childhood Vaccines 15-item survey and review vaccination certificates to assess vaccination status. We administer additional questions based on findings from qualitative research, addressing communication with medical providers, vaccine information sources and perceptions of risk control vis-à-vis vaccine-preventable diseases. The questionnaires capture sociodemographics, political views, religion and spirituality, and moral foundations.Ethics and disseminationThe study was approved by the local ethics committee. The results will be published in peer-reviewed journals and disseminated to healthcare professionals, researchers and the public via conferences and public presentations.

Patients discuss complementary and alternative medicine (CAM) in online health communities. Sometimes, patients’ conflicting opinions toward CAM-related issues trigger debates in the community. The objectives of this paper are to identify such debates, identify controversial CAM therapies in a popular online breast cancer community, as well as patients’ stances towards them. To scale our analysis, we trained a set of classifiers. We first constructed a supervised classifier based on a long short-term memory neural network (LSTM) stacked over a convolutional neural network (CNN) to detect automatically CAM-related debates from a popular breast cancer forum. Members’ stances in these debates were also identified by a CNN-based classifier. Finally, posts automatically flagged as debates by the classifier were analyzed to explore which specific CAM therapies trigger debates more often than others. Our methods are able to detect CAM debates with F score of 77%, and identify stances with F score of 70%. The debate classifier identified about 1/6 of all CAM-related posts as debate. About 60% of CAM-related debate posts represent the supportive stance toward CAM usage. Qualitative analysis shows that some specific therapies, such as Gerson therapy and usage of laetrile, trigger debates frequently among members of the breast cancer community. This study demonstrates that neural networks can effectively locate debates on usage and effectiveness of controversial CAM therapies, and can help make sense of patients’ opinions on such issues under dispute. As to CAM for breast cancer, perceptions of their effectiveness vary among patients. Many of the specific therapies trigger debates frequently and are worth more exploration in future work.

In addition to prescribed conventional medicines, many allogeneic hematopoietic stem cell transplant (HSCT) survivors also use complementary and alternative medical therapies (CAM), however, the frequency and types of CAMs used by allogeneic HSCT survivors remain unclear. Study participants were adults who had undergone an allogeneic HSCT between 1st January 2000 and 31st December 2012. Participants completed a 402‐item questionnaire regarding the use of CAM, medical complications, specialist referrals, medications and therapies, infections, vaccinations, cancer screening, lifestyle, and occupational issues and relationship status following stem cell transplantation. A total of 1475 allogeneic HSCT were performed in the study period. Of the 669 recipients known to be alive at study sampling, 583 were contactable and were sent study packs. Of 432 participants who returned the completed survey (66% of total eligible, 76% of those contacted), 239 (54.1%) HSCT survivors used at least one form of CAM. These included dietary modification (13.6%), vitamin therapy (30%), spiritual or mind–body therapy (17.2%), herbal supplements (13.5%), manipulative and body‐based therapies (26%), Chinese medicine (3.5%), reiki (3%), and homeopathy (3%). These results definitively demonstrate that a large proportion of HSCT survivors are using one or more form of CAM therapy. Given the potential benefits demonstrated by small studies of specific CAM therapies in this patient group, as well as clearly documented therapies with no benefit or even toxicity, this result shows there is a large unmet need for additional studies to ascertain efficacy and safety of CAM therapies in this growing population.

This commentary discusses the concept of value-based or value-focused health care as a rationale for researchers to incorporate mixed methods study designs a priori into clinical trials evaluating traditional, complementary, alternative, and integrative medicine (TCAIM). Along with assessing patient outcomes, information about patients’ experiences and preferences are needed to determine the value of an intervention. Incorporating a mixed-methods approach can improve the quality of clinical trials and provide important information about the potential value of the intervention.

More efficacious and better tolerated treatments for epilepsy are clearly needed. Complementary and alternative medicine (CAM) has a long history of use in certain parts of the world and has gained increasing interest over the last decades in Western countries. In countries with a Western-based type of medical system, people with epilepsy (PWE) take natural products or engage in other forms of CAM mainly to enhance general health, but also to prevent seizures or to alleviate symptoms of comorbidities or side effects of antiepileptic medications. In other countries, well developed medical systems, such as traditional Chinese Medicine and Ayurveda, are often the basis for treating PWE. Based on anecdotal reports of efficacy in PWE, natural products from these and other traditions are increasingly being studied in animal models of epilepsy, and candidates for further clinical development have been identified. It is likely, therefore, that natural products will be further evaluated for safety, tolerability and efficacy in PWE with drug-resistant seizures.

Herbal remedies are widely used for the treatment and prevention of various diseases and often contain highly active pharmacological compounds. Many medicinal herbs and pharmaceutical drugs are therapeutic at one dose and toxic at another. Toxicity related to traditional medicines is becoming more widely recognized as these remedies become popular in the Mediterranean region as well as worldwide. Most reports concerning the toxic effects of herbal medicines are associated with hepatotoxicity although reports of other toxic effects including kidney, nervous system, blood, cardiovascular and dermatologic effects, mutagenicity and carcinogenicity have also been published in the medical literature. This article presents a systematic review on safety of traditional Arab medicine and the contribution of Arab scholars to toxicology. Use of modern cell biological, biochemical,in vitroandin vivotechniques for the evaluation of medicinal plants safety is also discussed.

New approaches to spirituality go hand in hand with emerging physical, psychological and spiritual movements that have had a clear impact on many areas, and in particular on health and well-being. It is increasingly common to find nurses teaching yoga or doctors prescribing mindfulness. Use of socalled Complementary and Alternative Medicine (CAM) is becoming mainstream. Health centres, medical practices and even schools are offering a growing number of alternative therapies, resulting in the need for effective legal regulation of these activities, both in terms of professional recognition and training. In Spain, recent legislation represents a significant breakthrough in the regulation of yoga instruction, while in Catalonia legislation has been passed on licencing processes and the training of yoga teachers. This article focuses on these processes, raising some key unanswered questions, points of contact and divergence between governments and this services sector, and substantive differences among stakeholders themselves. El desarrollo de nuevas espiritualidades va acompañado de emergentes movimientos físicopsico-espirituales que han tenido un claro impacto en ámbitos distintos, pero especialmente en el de la salud y el bienestar debido a su intensa proliferación. Cada día es más frecuente encontrar enfermeros/as que ofrecen yoga a sus pacientes, médicos/as que recomiendan mindfulnes (meditación), etc. El uso de las llamadas Medicinas Alternativas y Complementarias (MAC) ocupa un lugar cada vez más destacado en nuestra sociedad. Se trata de una realidad ya bien visible en los conocidos centros, escuelas, consultas particulares, etc. de terapias alternativas. La proliferación de todos estos espacios terapéuticos camina de la mano de la necesidad de una regulación institucional tanto para el reconocimiento de profesionales que operan en este campo como para su formación. España, hoy es protagonista de un importante avance en materia jurídica en la regulación de la Instrucción en Yoga a raíz de los Reales Decretos publicados en los últimos años, así como de los procesos de acreditación y de habilitación de los profesores de yoga en el caso catalán. En este artículo vamos a ver como se está realizando dicho proceso, mostrando los interrogantes que se han generado, los acuerdos y las discrepancias entre el sector y la administración, así como dentro del propio sector.

Background: Pregnant women visit complementary/alternative health care practitioners in addition to regular maternal health care practitioners. A wide variation has been reported with regard to rates and determinants of use of complementary/alternative medicine (CAM), which may be due to heterogeneous populations. The aim of this study was to examine the prevalence and determinants of use of CAM practitioners by a homogeneous population of low-risk pregnant women in the Netherlands.Methods: Data from the population-based DELIVER study was used, concerning 1500 clients from twenty midwifery practices across the Netherlands in 2009 and 2010. CAM use was measured based on patient reports. Potential determinants were derived from Andersen's behavioural model of health care utilization.Results: The prevalence of CAM practitioner use by low-risk pregnant women was 9.4 %. Women were more likely to use CAM if they had supplementary health care insurance (OR 3.11; CI 1.41-6.85), rated their health as 'bad/fair' (OR 2.63; CI 1.65-4.21), reported a chronic illness or handicap (OR 1.93; CI 1.14-3.27), smoked during pregnancy (OR 1.88; CI 1.06-3.33), or used alcohol during pregnancy (OR 2.30; CI 1.46-3.63).Conclusions: CAM is relatively frequently used by low-risk pregnant women. Determinants revealed in this study diverge from other studies using heterogeneous populations. Maternal health care practitioners must be aware of CAM use by low-risk pregnant women and incorporate this knowledge into daily practice by actively discussing this subject with pregnant women.

Complementary and alternative medicine (CAM) including Japanese Kampo is known to have anticancer potential. An increasing number of cancer survivors are using CAM for disease prevention, immune system enhancement, and symptom control. Although there have been abundant previous clinical reports regarding CAM, scientific investigations aimed at acquiring quantifiable results in clinical trials, as well as basic research regarding CAM, have only recently been undertaken. Recent studies suggest that CAM enhancement of immune function is related to cytokines. This review provides a translational aspect of CAM, particularly Hozai in Kampo from both scientific and clinical points of view for further development of CAM for cancer treatment.

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. © 2014 Singer and Adams; licensee BioMed Central Ltd.

Introduction Diabetes mellitus is a major cause of morbidity and mortality worldwide, with a prevalence of 347 million in 2013. Complementary and Alternative Medicines (CAM) are a group of remedies that is fast gaining acceptance among individuals. Cinnamon, Bitter gourd (Momordica charantia) and Fenugreek (Trigonella foenum-graecum) are 3 widely used CAMs used worldwide for the treatment of diabetes. Data on safety and efficacy is limited, but the consumption is wide. Crepe ginger (Costus speciosus) and Ivy gourd (Coccinia grandis) are 2 plants used widely in the Asian region for their presumed hypoglycaemic properties. Objective In this review, we analyzed the available evidence for the 5 CAMs mentioned above in terms of in-vitro studies, animal studies sand clinical trials. We also describe the mechanisms of hypoglycaemia and safety concerns where there is available evidence. Results and conclusions Clinical trials that studied the hypoglycaemic effects of Cinnamon, bitter gourd, fenugreek and ivy gourd showed conflicting results. Direct comparison between studies remains a challenge in view of the baseline heterogeneity of subjects, differences in substrate preparation, variable end points and poor trial design. Short durations of study and small number of subjects studied is universal. Crepe ginger has not been studied adequately in humans to draw conclusions. In view of the high prevalence of use and safety and efficacy issues, there is an urgent need to study their hypoglycaemic and adverse effects in well-designed long-term clinical trials. Electronic supplementary material The online version of this article (doi:10.1186/1475-2891-13-102) contains supplementary material, which is available to authorized users.

Purpose: To explore how men’s Significant Others (SOs), including family members and close friends, contribute to the uptake and maintenance of specific CAM therapies. Methods: This study was the second, qualitative phase of a mixed-methods project investigating the use of CAM in an Australian male cancer population. Male participants were purposefully selected from a pool of 403 patients who answered a survey in the first quantitative phase (94% response rate and 86% consent rate for follow-up interview). Then semi-structured interviews among 26 men with a variety of cancers and 24 SOs were conducted. All 43 interviews were recorded, transcribed, and analysed thematically. Results: Men used CAM/Natural products to cope with physical concerns, and this was actively supported by men’s SOs who contributed to the uptake and maintenance of these CAMs. The shared CAM preparation and consumption functioned to strengthen the bond between men and their SOs, and also helped men’s SOs to cope with uncertainty and regain control. In contrast, men practiced CAM/Mind-body medicine to receive emotional benefits, and only rarely shared this practice with their SOs, indicating a need for coping with emotions in a private way. Conclusions: Men's CAM use is a multifaceted process that can be better understood by considering CAM categories separately. CAM/Natural products help men to cope with physical concerns, while CAM/Mind-body medicine assist men to cope with their emotions in a private way. Oncology professionals can use this information to better promote and implement integrative cancer care services. Refereed/Peer-reviewed

Studies have shown a high prevalence (40–83%) of complementary and alternative medicine (CAM) use among cancer patients in the U.S.A cross-sectional, mixed-methods pilot study was completed. This paper focuses on the quantitative analysis conducted on demographic predictors of complementary medicine (CM) use, reasons to use CM, and disclosure to healthcare provider data. Surveys were interview-administered at the Loma Linda University Medical Center Cancer Center. Participants, 18 years or older, were selected from a convenient sample. Eighty-seven percent (87.9%) of participants reported to have used CM as a cancer treatment and most reported to have used it “to help fight the cancer.” Women were eight-times more likely to use prayer. All non-Caucasian and Hispanic participants reported to use CM as a cancer therapy and none reported to use a CM provider. More women (72%) disclosed their CM use than men (53.3%). Different prevalences and predictors exist when differentiating CM modalities, reasons to use CM vary by gender, and disclosure proportions vary by gender.

Purpose: Our aim was to explore the effectiveness of energy healing, a commonly used complementary and alternative therapy, on well-being in cancer patients while assessing the possible influence on the results of participating in a randomized controlled trial.Methods: 247 patients treated for colorectal cancer (response rate: 31.5%) were either a) randomized to healing (RH) or control (RC) or b) had self selected the healing (SH) or control condition (SC), and completed questionnaires assessing well-being (QoL, depressive symptoms, mood, and sleep quality), attitude towards complementary and alternative medicine (CAM), and faith/spirituality at baseline, 1 week, and 2 months post-intervention. They also indicated, at baseline, whether they considered QoL, depressive symptoms, mood, and sleep quality as important outcomes to them.Results: Multilevel linear models revealed no overall effect of healing on QoL (p = 0.156), depressive symptoms (p = 0.063), mood (p = 0.079), or sleep quality (p = 0.346) in the intervention groups (RH, SH) compared with control (SC). Effects of healing on mood were only found for patients who had a positive attitude towards CAM and considered the outcome in question as important (SH: Regression coefficient: -8.78; SE: 2.64; CI: -13.96- -3.61; p = 0.001, and RH: Regression coefficient -7.45; SE: 2.76; CI: -12.86- -2.04; p=.007).Conclusion: Whereas it is generally assumed that CAMs such as healing have beneficial effects on well-being, our results indicated no overall effectiveness of energy healing on QoL, depressive symptoms, mood, and sleep quality in colorectal cancer patients. Effectiveness of healing on well-being was, however, related to factors such as self-selection and a positive attitude towards the treatment. Purpose: Our aim was to explore the effectiveness of energy healing, a commonly used complementary and alternative therapy, on well-being in cancer patients while assessing the possible influence on the results of participating in a randomized controlled trial. Methods: 247 patients treated for colorectal cancer (response rate: 31.5%) were either (a) randomized to healing (RH) or control (RC) or (b) had self selected the healing (SH) or control condition (SC), and completed questionnaires assessing well-being (QoL, depressive symptoms, mood, and sleep quality), attitude toward complementary and alternative medicine (CAM), and faith/spirituality at baseline, 1 week, and 2 months post-intervention. They also indicated, at baseline, whether they considered QoL, depressive symptoms, mood, and sleep quality as important outcomes to them. Results: Multilevel linear models revealed no overall effect of healing on QoL (p = 0.156), depres-sive symptoms (p = 0.063), mood (p = 0.079), or sleep quality (p = 0.346) in the intervention groups(RH, SH) compared with control (SC). Effects of healing on mood were only found for patientswho had a positive attitude toward CAM and considered the outcome in question as important(SH: Regression coefficient: -8.78; SE: 2.64; CI: -13.96 to -3.61; p = 0.001, and RH: Regressioncoefficient -7.45; SE: 2.76; CI: -12.86 to -2.04; p = 0.007).Conclusion: Whereas it is generally assumed that CAMs such as healing have beneficial effects onwell-being, our results indicated no overall effectiveness of energy healing on QoL, depressivesymptoms, mood, and sleep quality in colorectal cancer patients. Effectiveness of healing onwell-being was, however, related to factors such as self-selection and a positive attitude towardthe treatment.

Background The use of complementary and alternative medicine (CAM) and complementary and alternative therapies (CAT) during pregnancy is increasing. Scientific evidence for CAM and CAT in the field of obstetrics mainly covers pain relief in labor. Midwives are responsible for labor and delivery care: hence, their knowledge of CAM and CAT is important. The aims of this study are to describe the professional profile of midwives who provide care for natural childbirth in Catalan hospitals accredited as centers for normal birth, to assess midwives’ level of training in CAT and their use of these therapies, and to identify specific resources for CAT in labor wards. Methods A descriptive, cross-sectional, quantitative method was used to assess the level of training and use of CAT by midwives working at 28 hospitals in Catalonia, Spain, accredited as public normal birth centers. Results Just under a third of midwives (30.4%) trained in CAT after completion of basic training. They trained in an average of 5.97 therapies (SD 3.56). The number of CAT in which the midwives were trained correlated negatively with age (r = - 0.284; p

This article explores why women in rural and remote areas of Australia use complementary and alternative medicine (CAM) at higher rates than their counterparts in urban areas. Drawing on qualitative interviews with 60 women 60-65 years of age, currently living in rural Australia, we explore the possibility that CAM use in rural areas may be embedded in processes of spatialised identity-building and the health-creating practices of mobile, ex-urban, individuals who drive this process. We problematise previous explanations which suggest CAM use in rural areas is principally derived from a lack of biomedical service provision and enhanced community ties showing instead how and why identity and mobility are useful additional variables for understanding CAM use in rural areas. © 2013 Elsevier Ltd.

Background: Several studies have reported on the health benefits of applying an integrated complementary health care model. Purpose: This paper presents the results of pilot research focusing on the observations massage therapy students made about complementary health care education and integration during massage, chiropractic, and acupuncture treatments at two university clinics. Setting: Observations took place at Northwestern Health Sciences University’s associated clinics that offered massage, chiropractic, and acupuncture. Research Design: Students directly observed how clinicians and interns educated their patients and integrated other forms of complementary health care into their practice. Participants: chiropractors, massage therapists, and acupuncturists, and their patients. All participants were English-speaking and 18–65 years old. Main Outcome Measures: Observations recorded by students in journals about education and integration during massage therapy, chiropractic, and acupuncture treatments were coded and counted. Results: Qualitative observations showed that clinicians and interns educated patients to some degree, but the clinicians were less apt to integrate other modalities than the interns. Conclusions: Observations support that professional integrity may limit clinicians in their ability to integrate multiple modalities of health care while treating patients. Since it is well established that integration of multiple health care modalities is beneficial to patient health, it is recommended that clinics assist their clinical staff in applying an integrative approach to their practice.

Background Available measures of patient-reported outcomes for complementary and alternative medicine (CAM) inadequately capture the range of patient-reported treatment effects. The Self-Assessment of Change questionnaire was developed to measure multi-dimensional shifts in well-being for CAM users. With content derived from patient narratives, items were subsequently focused through interviews on a new cohort of participants. Here we present the development of the final version in which the content and format is refined through cognitive interviews. Methods We conducted cognitive interviews across five iterations of questionnaire refinement with a culturally diverse sample of 28 CAM users. In each iteration, participant critiques were used to revise the questionnaire, which was then re-tested in subsequent rounds of cognitive interviews. Following all five iterations, transcripts of cognitive interviews were systematically coded and analyzed to examine participants' understanding of the format and content of the final questionnaire. Based on this data, we established summary descriptions and selected exemplar quotations for each word pair on the final questionnaire. Results The final version of the Self-Assessment of Change questionnaire (SAC) includes 16 word pairs, nine of which remained unchanged from the original draft. Participants consistently said that these stable word pairs represented opposite ends of the same domain of experience and the meanings of these terms were stable across the participant pool. Five pairs underwent revision and two word pairs were added. Four word pairs were eliminated for redundancy or because participants did not agree on the meaning of the terms. Cognitive interviews indicate that participants understood the format of the questionnaire and considered each word pair to represent opposite poles of a shared domain of experience. Conclusions We have placed lay language and direct experience at the center of questionnaire revision and refinement. In so doing, we provide an innovative model for the development of truly patient-centered outcome measures. Although this instrument was designed and tested in a CAM-specific population, it may be useful in assessing multi-dimensional shifts in well-being across a broader patient population.

Background Patients receiving complementary and alternative medicine (CAM) therapies often report shifts in well-being that go beyond resolution of the original presenting symptoms. We undertook a research program to develop and evaluate a patient-centered outcome measure to assess the multidimensional impacts of CAM therapies, utilizing a novel mixed methods approach that relied upon techniques from the fields of anthropology and psychometrics. This tool would have broad applicability, both for CAM practitioners to measure shifts in patients' states following treatments, and conventional clinical trial researchers needing validated outcome measures. The US Food and Drug Administration has highlighted the importance of valid and reliable measurement of patient-reported outcomes in the evaluation of conventional medical products. Here we describe Phase I of our research program, the iterative process of content identification, item development and refinement, and response format selection. Cognitive interviews and psychometric evaluation are reported separately. Methods From a database of patient interviews (n = 177) from six diverse CAM studies, 150 interviews were identified for secondary analysis in which individuals spontaneously discussed unexpected changes associated with CAM. Using ATLAS.ti, we identified common themes and language to inform questionnaire item content and wording. Respondents' language was often richly textured, but item development required a stripping down of language to extract essential meaning and minimize potential comprehension barriers across populations. Through an evocative card sort interview process, we identified those items most widely applicable and covering standard psychometric domains. We developed, pilot-tested, and refined the format, yielding a questionnaire for cognitive interviews and psychometric evaluation. Results The resulting questionnaire contained 18 items, in visual analog scale format, in which each line was anchored by the positive and negative extremes relevant to the experiential domain. Because of frequent informant allusions to response set shifts from before to after CAM therapies, we chose a retrospective pretest format. Items cover physical, emotional, cognitive, social, spiritual, and whole person domains. Conclusions This paper reports the success of a novel approach to the development of outcome instruments, in which items are extracted from patients' words instead of being distilled from pre-existing theory. The resulting instrument, focused on measuring shifts in patients' perceptions of health and well-being along pre-specified axes, is undergoing continued testing, and is available for use by cooperating investigators.

Complementary and alternative medicine (CAM) is frequently used by patients with multiple sclerosis (MS). Some MS patients experience unexpected improvements of symptoms, which they relate to their use of CAM. The aim of this study was to obtain knowledge and develop understandings of such self-defined unexpected improvement of MS symptoms. Two cases were constructed based on documents and 12 qualitative interviews. Our aim was not to make generalisations from the cases, but to transfer knowledge as working hypotheses. We identified four health-related change processes: the process of losing bodily competence; the process of developing responsibility; the process of taking control; and the process of choosing CAM. The patients explained unexpected improvements in their MS symptoms as results of their own efforts including their choice and use of CAM. In our theoretical interpretations, we found the patients’ redefinition of history, the concept of treatment and the importance of conventional health care to be essential, and leading to a change of patients’ position towards conventional health care from recipients to explorers. The explorers can be perceived as boundary walkers reflecting limitations within the conventional health care system and as initiators regarding what MS patients find useful in CAM. Key words: Chronic illness, illness experience, complementary and alternative medicine, multiple sclerosis, coping, Norway (Published: 2 July 2010) Citation: Int J Qualitative Stud Health Well-being 2010, 5: 5032 - DOI: 10.3402/qhw.v5i2.5032

Complementary and alternative medicine (CAM) is widely used by patients worldwide. Financial factors may influence the decision to use CAM. National Health Systems are requested to consider CAM in their health plans.