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Background Although there is mounting clinical and cost-effectiveness evidence supporting integrative healthcare (IH), a significant knowledge gap hinders widespread adoption by primary care professionals. Intervention Based on IH competencies developed by an interprofessional team and a needs assessment, a 32-h online interprofessional IH course, Foundations in Integrative Health, was developed. Trainees learn to conduct an IH assessment and how patients are assessed and treated from the diverse professions in integrative primary care. Methods The course was pilot-tested with educational program trainees, faculty and clinical staff at graduate level primary care training programs (primary care residencies, nursing, pharmacy, public health, behavioral health, and licensed complementary and IH programs). Outcome measures Prior to and following the course, participants completed an IH knowledge test, an IH efficacy self-assessment, and validated measures of IH attitudes, interprofessional learning, provider empathy, patient involvement, resiliency, self-care, wellness behaviors, and wellbeing. Evaluation surveys were administered following each unit and the course. Results Almost one-half (n = 461/982, 47%) completed the course. Pre/post course improvements in IH knowledge, IH self-efficacy, IH attitudes, interprofessional learning, provider empathy, resiliency, self-care, several wellness behaviors, and wellbeing were observed. The course was positively evaluated with most (93%) indicating interest in applying IH principles and that the course enhanced their educational experience (92%). Conclusion This study demonstrates the feasibility and effectiveness of a multi-site, online curriculum for introducing IH to a diverse group of primary care professionals. Primary care training programs have the ability to offer an interprofessional, IH curriculum with limited on-site faculty expertise.

Online curricular interventions in residency have been proposed to address challenges of time, cost, and curriculum consistency. This study is designed to determine the feasibility and effectiveness of a longitudinal, multisite online curriculum in integrative medicine (IMR) for residents.Residents from eight family medicine programs undertook the 200-hour online IMR curriculum. Their medical knowledge (MK) scores at completion were compared to a control group from four similar residency programs. Study and control groups were comparable in baseline demographics, and MK scores. Course completion, MK scores, and course evaluations were assessed.Of 186 IMR residents, 76.9% met completion requirements. The IMR group showed statistically significant higher MK scores at residency completion, the control group did not (IMR: 79.2% vs.53.2% mean correct). Over three-fourths of IMR participants (range 79-92%) chose the top two rating categories for each course evaluation item. In an exit survey, ability to access the curriculum for 1 additional year and intention to utilize IM approaches after residency were the highest ranked items.The demonstrated feasibility, effectiveness, and positive evaluations of the IMR curriculum indicate that a multisite, online curricular intervention is a potentially viable approach to offering new curriculum with limited on-site faculty expertise for other family medicine residencies.

Background Investigators of homeopathy have proposed that nonlinear dynamical systems (NDS) and complex systems science offer conceptual and analytic tools for evaluating homeopathic remedy effects. Previous animal studies demonstrate that homeopathic medicines alter delta electroencephalographic (EEG) slow wave sleep. The present study extended findings of remedy-related sleep stage alterations in human subjects by testing the feasibility of using two different NDS analytic approaches to assess remedy effects on human slow wave sleep EEG. Methods Subjects ( N = 54) were young adult male and female college students with a history of coffee-related insomnia who participated in a larger 4-week study of the polysomnographic effects of homeopathic medicines on home-based all-night sleep recordings. Subjects took one bedtime dose of a homeopathic remedy ( Coffea cruda or Nux vomica 30c). We computed multiscale entropy (MSE) and the correlation dimension (Mekler-D2) for stages 3 and 4 slow wave sleep EEG sampled in artifact-free 2-min segments during the first two rapid-eye-movement (REM) cycles for remedy and post-remedy nights, controlling for placebo and post- placebo night effects. Results MSE results indicate significant, remedy-specific directional effects, especially later in the night (REM cycle 2) (CC: remedy night increases and post-remedy night decreases in MSE at multiple sites for both stages 3 and 4 in both REM cycles; NV: remedy night decreases and post-remedy night increases, mainly in stage 3 REM cycle 2 MSE). D2 analyses yielded more sporadic and inconsistent findings. Conclusions Homeopathic medicines Coffea cruda and Nux vomica in 30c potencies alter short-term nonlinear dynamic parameters of slow wave sleep EEG in healthy young adults. MSE may provide a more sensitive NDS analytic method than D2 for evaluating homeopathic remedy effects on human sleep EEG patterns.

Electroencephalography (EEG) offers psychophysiologic tools to improve sensitivity for detecting objective effects in complementary and alternative medicine. This current investigation extended prior clinical research studies to evaluate effects of one of two different homeopathic remedies on resting EEG cordance after an olfactory activation protocol on healthy young adults with remedy-relevant, self-perceived characteristics.Ninety-seven (7) young adults (N=97, mean age 19 years, 55% women) with good self-rated global health and screened for homeopathic constitutional types consistent with one of two remedies (either Sulphur or Pulsatilla) underwent three weekly laboratory sessions. At each visit, subjects had 5-minute resting, eyes-closed EEG recordings before and after a placebo-controlled olfactory activation task with their constitutionally relevant verum remedy. One remedy potency (6c, 12c, or 30c) used per week, was presented in a randomized order over the 3 sessions. Prefrontal resting EEG cordance values at Fp1 and Fp2 were computed from artifact-free 2-minute EEG samples from the presniffing and postsniffing rest periods. Cordance derives from an algorithm that incorporates absolute and relative EEG values.The data showed significant two-way oscillatory interactions of remedy by time for ß, α, θ, and δ cordance, controlling for gender and chemical sensitivity.EEG cordance provided a minimally invasive technique for assessing objective nonlinear physiologic effects of two different homeopathic remedies salient to the individuals who received them. Time factors modulated the direction of effects. Given previous evidence of correlations between cordance and single-photon emission computed tomography, these findings encourage additional neuroimaging research on nonlinear psychophysiologic effects of specific homeopathic remedies.

Introduction Homeopathic pathogenetic trials usually rely on symptom self report measures. Adding objective biomarkers could enhance detection of subtle initial remedy effects. The present feasibility study examined electroencephalographic (EEG) effects of repeated olfactory administration of two polycrest remedies. Methods College student volunteers (ages 18–30, both sexes) from an introductory psychology course were screened for good health and relatively elevated Sulphur or Pulsatilla symptom scores on the Homeopathic Constitutional Type Questionnaire (CTQ). Subjects underwent a series of 3 once-weekly double-blind sessions during which they repeatedly sniffed the remedy matched to their CTQ type and solvent controls. Each remedy was given in a 6c, 12c, and 30c potency, one potency per week, in randomly assigned order. Solvent controls included both plain distilled water and a water–ethanol (95%) solution. All sniff test solutions were further diluted just prior to laboratory sessions (0.5 ml test solution in 150 ml distilled water). Within a session, remedies and control solvents were administered via 2-s sniffs (8 sniffs of each of 4 different succussion levels for the potency in randomized order). Primary outcome variable was relative EEG power (alpha 1 8–10 Hz; alpha 2 10–12 Hz) averaged over 19 electrode sites, including all succussions for a given potency. Results Mixed-effect models revealed significant main effects for remedy type (Sulphur > Pulsatilla) in both alpha bands, controlling for gender, baseline resting EEG alpha, and solvent control responses. Additional analyses showed significant nonlinear interactions between dilution and time (weekly session) in alpha 2 for both remedies and alpha 1 for Sulphur. Conclusion EEG alpha offers an objective biomarker of remedy effects for future studies and potential method for distinguishing time-dependent effects of specific remedies and remedy potencies from one another.

The National Institute of Drug Abuse's National Drug Abuse Treatment Clinical Trials Network (CTN) was established to foster translation of research into practice in substance abuse treatment settings. The CTN provides a unique opportunity to examine in multi-site, translational clinical trials, the outcomes of treatment interventions targeting vulnerable subgroups of women; the comparative effectiveness of gender-specific protocols to reduce risk behaviors; and gender differences in clinical outcomes.To review gender-related findings from published CTN clinical trials and related studies from January 2000 to March 2010.CTN studies were selected for review if they focused on treatment outcomes or services for special populations of women with substance use disorders (SUDs) including those with trauma histories, pregnancy, co-occurring eating and other psychiatric disorders, and HIV risk behaviors; or implemented gender-specific protocols. The CTN has randomized 11,500 participants (41% women) across 200 clinics in 24 randomized controlled trials in community settings, of which 4 have been gender-specific.This article summarizes gender-related findings from CTN clinical trials and related studies, focusing on trauma histories, pregnancy, co-occurring eating and other psychiatric disorders, and HIV risk behaviors.These published studies have expanded the evidence base regarding interventions for vulnerable groups of women with SUDs as well as gender-specific interventions to reduce HIV risk behaviors in substance-using men and women. The results also underscore the complexity of accounting for gender in the design of clinical trials and analysis of results.To fully understand the relevance of gender-specific moderators and mediators of outcome, it is essential that future translational studies adopt more sophisticated approaches to understanding and measuring gender-relevant factors and plan sample sizes that are adequate to support more nuanced analytic methods.

The purpose of the present study was to determine the effectiveness of Johrei healing, a form of energy healing, on substance use and psychologic symptoms in a sample of clients receiving substance abuse treatment.Twenty-one (21) persons in residential substance-abuse treatment participated in a randomized, wait-list control pilot study of Johrei healing. Twelve (12) of the participants received three 20-minute Johrei sessions for 5 weeks in addition to their regular treatment.The results are from the first treatment wave. Individual healing sessions were evaluated pre-post with the Johrei Experience Scale. Participants showed significant decreases in stress/depression and physical pain and increases in positive emotional/spiritual state, energy, and overall well-being after an individual Johrei healing session. The Global Assessment of Individual Need (GAIN), Profile of Mood States (POMS), General Alcoholics Anonymous Tools of Recovery, and 12-Step Participation scales were administered before and after the 5-week intervention to assess change in substance use, psychologic distress, mood, and 12-Step participation. Improvements in depression and trauma symptoms, externalizing behaviors (GAIN), and vigor (POMS) were found for the treatment group. Despite comparable 12-Step attendance the treatment group showed greater improvement than the wait-list control group in the use of 12-Step recovery tools. No difference in substance use was found between the two groups.Variables related to substance use and relapse showed improvement in the treatment group suggesting that Johrei healing shows promise and should be studied with a larger sample, over a longer treatment period, with sham controls.

To characterize initial central nervous system responses to olfactory administration of homeopathic remedies as biomarkers for subsequently exceptional, simillimum-like clinical outcomes at a systemic level (i.e., both locally and globally).Double-blinded, randomized, placebo-controlled clinical trial.A private homeopathic clinic in Phoenix, AZ, and a university laboratory in Tucson, AZ.Sixty-two (62) persons with physician-confirmed fibromyalgia (FM) (mean age, 49 years; 94% women) enrolled; 53 completed the 3-month assessment visit. Exceptional responders (n = 6, 23% of active treatment group; none on placebo) were those with improvements in the top one-third for both tender point pain and global health ratings after 3 months.Patients took daily oral doses of treatment solution in LM (1/50,000 dilution) potency (active group received individualized remedy; placebo group received plain solvent). Dependent measures: Baseline and 3-month difference scores for initial prefrontal electroencephalographic alpha frequency cordance (EEG-C, a correlate of functional brain activity) during 16 pairs of randomized, double-blinded bottle sniffs (treatment minus control solutions).Exceptional responders versus other patients exhibited significantly more negative initial EEG-C difference scores at prefrontal sites. Right prefrontal cordance findings correlated with subsequently reduced pain (r = 0.85, p = 0.03), better global health (r =-0.73, p = 0.10), and trait absorption (genetically determined ability to focus attention selectively and fully) (r = 0.91, p = 0.012).These observations suggest prefrontal EEG-C as an early biomarker of individualized homeopathic medicine effects in patients with FM who later exhibit exceptional outcomes. Prefrontal cortex controls executive function, including ability to redirect attention. Interactions between executive function, absorption, and the simillimum remedy could facilitate exceptional responses.

Fibromyalgia (FM) patients show evidence of sensitizability in pain pathways and electroencephalographic (EEG) alterations. One proposed mechanism for the claimed effects of homeopathy, a form of complementary medicine used for FM, is time-dependent sensitization (TDS, progressive amplification) of host responses. This study examined possible sensitization-related changes in EEG relative alpha magnitude during a clinical trial of homeopathy in FM. A 4-month randomized, placebo-controlled double-blind trial of daily orally administered individualized homeopathy in physician-confirmed FM, with an additional 2-month optional crossover phase, included three laboratory sessions, at baseline, 3 and 6 months (N = 48, age 49.2 +/- 9.8 years, 94% women). Nineteen leads of EEG relative alpha magnitude at rest and during olfactory administration of treatment and control solutions were evaluated in each session. After 3 months, the active treatment group significantly increased, while the placebo group decreased, in global alpha-1 and alpha-2 during bottle sniffs over sessions. At 6 months, the subset of active patients who stayed on active continued to increase, while the active-switch subgroup reversed direction in alpha magnitude. Groups did not differ in resting alpha. Consistent with the TDS hypothesis, sniff alpha-1 and alpha-2 increases at 6 months versus baseline correlated with total amount of time on active remedy over all subjects (r = 0.45, p = .003), not with dose changes or clinical outcomes in the active group. The findings suggest initiation of TDS in relative EEG alpha magnitude by daily oral administration of active homeopathic medicines versus placebo, with laboratory elicitation by temporolimbic olfactory stimulation or sniffing.

While adolescent substance use has been the focus of extensive research over the last few decades, Hispanic adolescent substance use has received only limited attention. Studies exploring predictors of Hispanic adolescent substance use have failed to adequately explore the contribution of the family on substance use. The present study examined the relative influence of family, school and peer influences, perceived student substance use, family substance use, and acculturation on a sample of Mexican-American early adolescents using structural equations modeling. The findings varied for males and females. Family functioning and family use directly influenced substance use for males. Family functioning influenced school and peer variables, however, these were unrelated to use. For females, family use and student use directly influenced substance use. Family functioning influenced family use and school and peer attachments. School and peer attachment predicted perceived student use. These findings suggest that family functioning has a primary role in Hispanic adolescent substance use.

Co-occurring mental health and substance use disorders (COD) are common and frequently under-detected, which may lead to less than optimal treatment for persons in psychosocial rehabilitation settings. A new, relatively brief instrument, the Comprehensive Addictions and Psychological Evaluation (CAAPE) was compared with the Structured Clinical Interview for DSM-IV (SCID). The CAAPE required less time to administer than the SCID, efficiently explored DSM substance use disorder criteria and served as a screen for psychiatric disorders. The CAAPE promises to be a useful screening and diagnostic instrument for persons with co-occurring disorders, especially suited for use in psychosocial rehabilitation.

Objectives: The aim of this study was to examine the effects of giving and receiving Johrei, a spiritual energy healing practice, on measures of well-being. Methods: Participants (N = 236) rated 21 items pertaining to feelings plus an overall well-being measure, before and after a Johrei session. Results: Receivers experienced a significantly greater decrease in negative emotional state than givers; however, givers and receivers experienced a comparable increase in positive emotional state and overall well-being. Conclusions: The practice of Johrei and other energy and spiritual healing techniques, may have positive health effects for givers as well as receivers. Future research examining different energy and spiritual healing practices (for example, Reiki and Therapeutic Touch) and using various control groups (for example, treatmentnaive subjects instructed to "send loving energy") can explore the generality and mechanisms underlying these apparently robust effects.

Stress in medical education has been well documented, often with the primary focus on negative factors such as depression and burnout. Few studies have attempted to assess well-being mediating behaviors. This study describes the relationship between wellness behaviors and measures of well-being at the start of family medicine residency.Using an online questionnaire, first-year family medicine residents (n=168) completed standardized measures exploring perceived stress, depression, satisfaction with life, and burnout. A lifestyle wellness behavior measure was developed for the study.Average reported perceived stress levels were consistent with ranges found for medical students and residents. Twenty-three percent of residents scored in a range consistent with depression risk. In terms of burnout risk, 13.7% scored in the high emotional exhaustion range and 23.8% in the high depersonalization range. Two thirds reported high life satisfaction. Higher depersonalization and less time in nurturing relationships were associated with greater likelihood of medication use for sleep, mood, and anxiety in females. Higher alcohol use was associated with increased levels of perceived stress, burnout, and depression. The two wellness behaviors most associated with higher well-being were restful sleep and exercise.At the start of residency, well-being measures are consistent with findings in medical school. Restful sleep and exercise were associated with more positive well-being. Future longitudinal data analysis will help clarify the effect of residency training in well-being and lifestyle behaviors. Identification of protective factors and coping mechanisms could guide residencies in incorporating support services for residents.

Introduction Healthcare reform is highlighting the need for more family practice and other primary care physicians. The Integrative Medicine in Residency (IMR) curriculum project helped family medicine residencies pilot a new, online curriculum promoting prevention, patient-centered care competencies, use of complementary and alternative medicine along with conventional medicine for management of chronic illness. A major potential benefit of the IMR program is enhanced recruitment into participating residencies, which is reported here. Methods Using an online questionnaire, accepted applicants to the eight IMR pilot programs ( n = 152) and four control programs ( n = 50) were asked about their interests in learning integrative medicine (IM) and in the pilot sites how the presence of the IMR curriculum affected their ranking decisions. Results Of residents at the IMR sites, 46.7% reported that the presence of the IMR was very important or important in their ranking decision. The IMR also ranked fourth overall in importance of ranking after geography, quality of faculty, and academic reputation of the residency. The majority of IMR residents (87.5%) had high to moderate interest in learning IM during their residency; control residents also had a high interest in learning IM (61.2%). Conclusions The presence of the IMR curriculum was seen as a strong positive by applicants in ranking residencies. Increasing the adoption of innovative IM curricula, such as the IMR, by residency programs may be helpful in increasing applications of competitive medical students into primary care residencies as well as in responding to the expressed interest in learning the IM approach to patient care.

This study examined the effect of Emotional Freedom Techniques (EFT), a brief exposure therapy combining cognitive and somatic elements, on posttraumatic stress disorder (PTSD) and psychological distress symptoms in veterans receiving mental health services. Veterans meeting the clinical criteria for PTSD were randomized to EFT (n = 30) or standard of care wait list (SOC/WL; n = 29). The EFT intervention consisted of 6-hour-long EFT coaching sessions concurrent with standard care. The SOC/WL and EFT groups were compared before and after the intervention (at 1 month for the SOC/WL group and after six sessions for the EFT group). The EFT subjects had significantly reduced psychological distress (p < 0.0012) and PTSD symptom levels (p < 0.0001) after the test. In addition, 90% of the EFT group no longer met PTSD clinical criteria, compared with 4% in the SOC/WL group. After the wait period, the SOC/WL subjects received EFT. In a within-subjects longitudinal analysis, 60% no longer met the PTSD clinical criteria after three sessions. This increased to 86% after six sessions for the 49 subjects who ultimately received EFT and remained at 86% at 3 months and at 80% at 6 months. The results are consistent with that of other published reports showing EFT's efficacy in treating PTSD and comorbid symptoms and its long-term effects.

Issues related to medication use by teens with asthma were studied. Adolescents 13-17 years old who were receiving drug therapy for asthma were recruited to participate in focus groups. Facilitators asked open-ended questions, and the discussion was recorded and coded for content. Participants were asked to complete questionnaires covering attitudes and beliefs, family issues, and communication with physicians and pharmacists. Of 28 teens participating in the focus groups, 26 returned completed questionnaires. The teens considered themselves compliant with medication therapy. They said they talked more to physicians than to pharmacists and received more oral and written information from the physicians. Focus group responses indicated that teens wanted complete responsibility for taking their medications and experienced conflict with adults--parents, teachers, school nurses, and physicians--about medication use. The teens were concerned about adverse effects and the cost of medications and wanted more information about asthma and its treatment. The teens did not disobey their parents or physicians by refusing to take their medications, and peers did not have a negative influence on the teens' asthma management. The primary medication issue for this group of adolescents was managing their medication to control their asthma in spite of inappropriate rules or behavior by adults.

This study examined the changes in cortisol levels and psychological distress symptoms of 83 nonclinical subjects receiving a single hour long intervention. Subjects were randomly assigned to either an emotional freedom technique (EFT) group, a psychotherapy group receiving a supportive interviews (SI), or a no treatment (NT) group. Salivary cortisol assays were performed immediately before and 30 minutes after the intervention. Psychological distress symptoms were assessed using the symptom assessment-45. The EFT group showed statistically significant improvements in anxiety (-58.34%, p < 0.05), depression (-49.33%, p < 0.002), the overall severity of symptoms (-50.5%, p < 0.001), and symptom breadth (-41.93%, p < 0.001). The EFT group experienced a significant decrease in cortisol level (-24.39%; SE, 2.62) compared with the decrease observed in the SI (-14.25%; SE, 2.61) and NT (-14.44%; SE, 2.67) groups (p < 0.03). The decrease in cortisol levels in the EFT group mirrored the observed improvement in psychological distress.

The purpose of this within-subjects feasibility study was to determine whether two different homeopathic remedies, Nux Vomica (NV) and Coffea Cruda (CC), exert effects on subjective mood ratings in healthy adults with a history of coffee-induced insomnia. The impact of individual personality traits, anxiety sensitivity or Type A cynical hostility, and homeopathic constitutional type (HTYPE-NV, HTYPE-CC), on remedy effects was examined to evaluate differential responsivity, in accord with clinical claims.Young adults of both sexes (ages 18-31) with above-average scores on standardized personality scales for either cynical hostility or anxiety sensitivity, and a history of coffee-induced insomnia, participated in the month-long study. At-home polysomnographic recordings were obtained on successive pairs of nights once per week for a total of 8 recordings (nights 1, 2, 8, 9, 15, 16, 22, 23). Subjects (N = 59) received placebo pellets on night 8 (single-blind) and verum pellets in 30c doses of one of two homeopathic remedies, NV or CC, on night 22 (doubleblind). Subjects completed the Profile of Mood States Scales at bedtime.The remedies produced differential effects on anger and overall mood, with improved mood following CC administration. A similar trend for depression was observed. Anxiety sensitive subjects experienced less tension following CC, whereas hostile subjects receiving CC became more tense. The high HTYPE-CC receiving CC experienced less vigor. The high HTYPE-CC receiving NV experienced more vigor.

This study examined gender differences in the rates and correlates of HIV risk behaviors among 1,429 clients participating in multi-site trials throughout the United States between 2001 and 2005 as part of the National Institute on Drug Abuse-funded Clinical Trials Network. Women engaged in higher risk sexual behaviors. Greater alcohol use and psychiatric severity were associated with higher risk behaviors for women, while impaired social relations were associated with decreased risk for men. Specific risk factors were differentially predictive of HIV risk behaviors for women and men, highlighting the need for gender-specific risk-reduction interventions. Limitations of the study are discussed.

Previous research indicates that a large cohort of veterans from the 1991 Gulf War report polysymptomatic conditions. These syndromes often involve neurocognitive complaints, fatigue, and musculoskeletal symptoms, thus overlapping with civilian illnesses from low levels of environmental chemicals, chronic fatigue syndrome, and fibromyalgia.To test for time-dependent changes over repeated intermittent exposures, we evaluated objective performance on a computerized visual divided attention test in chronically unhealthy Gulf War veterans (n = 22 ill with low-level chemical intolerance (CI); n = 24 ill without CI), healthy Gulf War veterans (n = 23), and healthy Gulf War era veterans (n = 20). Testing was done before and after each of three weekly, double blind, low-level JP-8 jet fuel or clean air sham exposure laboratory sessions, including acoustic startle stimuli.Unhealthy veterans receiving jet fuel had faster mean peripheral reaction times over sessions compared with unhealthy veterans receiving sham clean air exposures. Unhealthy Gulf veterans with CI exhibited faster post- vs. pre-session mean central reaction times compared with unhealthy Gulf veterans without CI. Findings were controlled for psychological distress variables.These data on unhealthy Gulf veterans show an acceleration of divided attention task performance over the course of repeated low-level JP-8 exposures. The present faster reaction times are consistent with rat neurobehavioral studies on environmental toxicant cross-sensitization and nonlinear dose-response patterns with stimulant drugs, as well as some previous civilian studies using other exposure agents. Together with previous research findings, the data suggest involvement of central nervous system dopaminergic pathways in affected Gulf veterans.

To assess individual difference characteristics of subgroups of patients with fibromyalgia (FM) patients with respect to the decision to stay in or switch from randomly-assigned verum or placebo treatment during an optional crossover phase of a double-blinded homeopathy study.Double-blinded, randomized, placebo-controlled, optional crossover clinical trial.Fifty-three (53) community-recruited patients with FM entered the optional crossover phase.Two homeopaths jointly selected an individualized homeopathic remedy for all patients. The pharmacy dispensed either verum LM remedy or indistinguishable placebo in accord with randomized assignment for 4 months and the patient's optional crossover decision for an additional 2 months.Patients completed a battery of baseline state/trait questionnaires, including mood, childhood neglect and abuse, and trait absorption. They rated global health (whole person-centered) and tender point pain on physical examination (disease-specific) at baseline, 3 months, and 6 months.Rates of optional crossover from verum to placebo or placebo to verum were comparable (p = 0.6; 31%, and 41%, respectively). The switch subgroups had greater baseline psychologic issues (emotional neglect in placebo-switch; depression and anger in verum-switch). The verum-stay subgroup scored highest on treatment helpfulness and included all six exceptional responders who fell, prior to crossover, into the top terciles for improvement in both global health and pain. Patients staying in their randomly assigned groups, active or placebo (n = 34), scored significantly higher in trait absorption than did those who switched groups (n = 19).Individual difference factors may predict better and poorer responders with FM to specific and nonspecific effects of homeopathic and placebo treatment.

To explore associations between a global rating for the classical homeopathic construct of vital force and clinician and patient ratings on previously validated bio-psycho-social-spiritual questionnaires.Sixty-two (62) community-recruited patients with fibromyalgia (FM) were assessed at baseline prior to a clinical trial of individualized homeopathy. Two homeopaths jointly performed case-taking interviews. A conventional medical provider independently evaluated patients with a standardized history and physical examination. Homeopaths rated each patient's vital force (five-point Likert scale, with 1 = very weak to 5 = very strong). Homeopaths and the conventional medical provider rated their Clinical Global Impression (CGI) of the severity of illness (1 = normal; 7 = among the most extremely ill). Patients completed self-rating scales on pain, global health, mood, quality of life, coping style, health locus of control, multidimensional well-being, spirituality, sense of coherence, positive states of mind, and social desirability.Greater vital force ratings (mean 2.9 standard deviation [SD] 0.6) correlated moderately (por = 0.005) with less severe CGI illness ratings by the homeopaths (r =-0.59), decreased patient-rated mental confusion (r =-0.43), higher vigor (r = 0.38), and greater positive states of mind (r = 0.36). Vital force also showed correlations (p0.05) with lower CGI ratings by the conventional medical provider (r =-0.32), better selfrated quality of life (r = 0.33), lesser fatigue (r =-0.31), better global health (r = 0.29), greater sense of coherence (r = 0.28), powerful-others health locus of control (r = 0.27), increased emotional well-being (r = 0.27), and higher social desirability (r = 0.27), but not with age, pain, or illness duration.Homeopathic vital force ratings reflect better perceived mental function, energy, and positive dimensions of the individual, beyond absence of disease.

Objective To assess the efficacy of individualized classical homeopathy in the treatment of fibromyalgia. Methods This study was a double-blind, randomized, parallel-group, placebo-controlled trial of homeopathy. Community-recruited persons (N = 62) with physician-confirmed fibromyalgia (mean age 49 yr, s.d. 10 yr, 94% women) were treated in a homeopathic private practice setting. Participants were randomized to receive oral daily liquid LM (1/50,000) potencies with an individually chosen homeopathic remedy or an indistinguishable placebo. Homeopathic visits involved joint interviews and concurrence on remedy selection by two experienced homeopaths, at baseline, 2 months and 4 months (prior to a subsequent optional crossover phase of the study which is reported elsewhere). Tender point count and tender point pain on examination by a medical assessor uninvolved in providing care, self-rating scales on fibromyalgia-related quality of life, pain, mood and global health at baseline and 3 months, were the primary clinical outcome measures for this report. Results Fifty-three people completed the treatment protocol. Participants on active treatment showed significantly greater improvements in tender point count and tender point pain, quality of life, global health and a trend toward less depression compared with those on placebo. Conclusions This study replicates and extends a previous 1-month placebo-controlled crossover study in fibromyalgia that pre-screened for only one homeopathic remedy. Using a broad selection of remedies and the flexible LM dose (1/50,000 dilution factor) series, the present study demonstrated that individualized homeopathy is significantly better than placebo in lessening tender point pain and improving the quality of life and global health of persons with fibromyalgia.

The purpose of this study was to compare the effectiveness of 12-step and cognitive-behavioral (Self-Management and Recovery Training [SMART]) approaches for persons with a dual diagnosis of serious mental illness and substance use disorder in an intensive outpatient/partial hospitalization setting. Participants (n = 112) were alternately assigned to the two treatment conditions, with 50 participants completing the 6-month treatment program. Assessments occurred at baseline, 3 months, and 6 months during treatment, and at 3- and 12-month follow-ups. Analyses were conducted on participants who had completed 3 months of treatment (n = 70). The 12-step intervention was more effective in decreasing alcohol use and increasing social interactions. However, a worsening of medical problems, health status, employment status, and psychiatric hospitalization were associated with the 12-step intervention. SMART was more effective in improving health and employment status, but marijuana use was greater for SMART participants. Improvements in alcohol use and life satisfaction occurred in both approaches. Covariates associated with treatment outcome were identified, with greater attendance being positively related to outcome. Involvement with the criminal justice system was positively related to treatment completion but negatively associated with medical problems. Less alcohol use, fewer medical problems, and better financial well-being at baseline were associated with better attendance.

Complementary and alternative medicine (CAM) use and expenditures are on the rise in the United States. Although civilian users of CAM have been well described, little is known about military veteran users of CAM.To describe military veteran CAM users in the southwestern United States.The study population comprised 508 military veterans randomly selected from Southern Arizona Veterans Administration Health Care System (Tucson) primary care patient lists, who had agreed to participate in a telephone interview. The chi(2) test was used to analyze CAM use by demographic characteristics, military service, military-related health outcomes, and physician-diagnosed health complaints. Logistic regression was used to determine predictor variables.Of the 508 subjects, 252 (49.6%) reported CAM use. Military veteran CAM users were significantly more likely to be non-Hispanic white, earn more than $50 000 per year (both P.05), and have greater than 12 years of education (P.01). Current high daily stress, perceived negative impact of military life on physical or mental health, and physician-diagnosed chronic illnesses (eg, gastrointestinal problems, insomnia, and asthma) were statistically associated with CAM use. Regression analysis provided adjusted odds ratios and indicated that ethnicity (non-Hispanic white), higher education, greater current daily stress, and overseas military experience were significant predictors of CAM use by these veterans (each P.05).Ethnicity, education, income, and several chronic health complaints are consistent with civilian CAM use. Findings also suggest, however, that physicians providing conventional medical care need to be aware of experiences unique to CAM-using military veterans.

Background Use of complementary and alternative medicine (CAM) is growing quickly in the USA, prompting hypotheses about why people turn to CAM. One reason for increasing use of CAM modalities may be dissatisfaction with the conventional care system. However, recent studies suggest that dissatisfaction is not a major factor. Objectives This paper provides another perspective on the possible relationship between dissatisfaction with conventional care and the use of CAM. Methods Qualitative data collection, in the form of 12 focus groups with 100 CAM users, was used to inquire about issues surrounding the use of CAM. Focus group participants were military veterans enrolled in the Southern Arizona VA Health Care System, and their significant others. Qualitative analysis identified key themes emerging from the focus groups. Results Although participants were satisfied in general terms with their conventional care, there were particular aspects of the conventional care system that they criticized. Dissatisfaction with aspects of conventional care, particularly its reliance on prescription medications, was an important component in their motivation to use CAM. Results also suggest that the conventional medical system's lack of holism (inadequate information regarding diet, nutrition and exercise, and ignorance of social and spiritual dimensions) is also an important motivation for turning to CAM in this particular population. Conclusions Independent research and a sense of responsibility on the part of focus group participants for their own health seemed to be taking them outside the domain of the conventional health care system.