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Healthy aging is an integrated "whole person" process that involves an individual's biology, behavior, and social/physical environment. With the recent development of antiaging drugs, careful consideration of the respective roles of pharmacologic and nonpharmacologic approaches to both health and aging is in order. Recent advances in understanding the cellular and molecular mechanisms of aging are providing new measures that can be used as clinical outcomes in studying the impact of antiaging interventions in humans. This paper outlines the strategic interest of the National Center for Complementary and Integrative Health (NCCIH) in supporting the development, testing, and implementation of effective, scalable, and integrated multicomponent interventions to support healthy aging of the whole person. [ABSTRACT FROM AUTHOR]

Objectives: Complementary health approaches include herbal products and mind–body practices. Several studies have identified predictors for complementary health approach use, yet there are two gaps: (1) How does use change? (2) Do factors associated with use influence this change over time? Using the Midlife in the United States (MIDUS), we examined how sociodemographic factors affected use longitudinally, and whether these associations differed between new and continued/discontinued use of herbal products, meditation, chiropractic, and massage therapy. Design: MIDUS is a national probability sample of adults aged 25 or older that has collected more than 20 years of longitudinal data, including the use of complementary health approaches. We employed the Andersen Model as a framework to identify predisposing, enabling, and health need factors associated with complementary health approach use based on previously identified and hypothesized factors. We ran Chi-square analyses to first test bivariate associations between our independent variables and four modalities to further guide logistic regression models. Results: Each of the four approaches examined saw substantial increases in prevalent use. However, only about 25% to 38% of individuals continued use from one wave to the next, whereas only 2%–9% of individuals who did not use a given approach in a wave reported use in the subsequent wave. Age, spiritual importance, and previous wave one use were all significantly associated with new use across all four modalities. Previous wave one use was associated with continued/discontinued use for all modalities. Age and education were significantly associated with discontinued use of chiropractic. Conclusion: We present the first longitudinal analysis of complementary health approaches in a nationally representative sample. These data distinguish between new and continued/discontinued use of complementary health approaches over time and provide insights into the interpretation of complementary health approach prevalence data, as well as important predictors of use. [ABSTRACT FROM AUTHOR]

Research on stakeholders in mild traumatic brain injury (mTBI) management in the schools has shown that several school personnel (e.g., nurses, athletic trainers, principals, speech-language pathologists) all contribute unique knowledge to a school-based mTBI management team. Special educators (SPEs) may be another stakeholder group that could provide additional knowledge and expertise in working with children in the schools following mTBI. We examined SPEs knowledge and perceptions of ability to support students with mTBI through an online survey. Results suggested that SPEs may provide unique, valuable knowledge that warrants their involvement on an mTBI management team. Similar to other school personnel, data from SPEs revealed specific areas of knowledge, as well as specific areas where knowledge was lacking. With additional focused continuing education and more clearly defined roles, SPEs may be an integral member of mTBI management teams. [ABSTRACT FROM AUTHOR]

The Department of Defense (DoD) and the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) cosponsored a workshop that explored the possible benefits of acupuncture treatment for acute pain. One goal of the workshop was to establish a roadmap to building an evidence base on that would indicate whether acupuncture is helpful for treating active-duty military personnel experiencing acute pain. The workshop highlighted brief presentations on the most current research on acupuncture and acute pain mechanisms. The impact of various modifiers (stress, genetics, population, phenotypes, etc.) on acute pain pathways and response to acupuncture treatment was discussed. Additional presentations focused on common neural mechanisms, an overview of real-world experience with using acupuncture to treat traumatic acute pain, and best tools and methods specific for acupuncture studies. Three breakout groups addressed the gaps, opportunities, and barriers to acupuncture use for acute pain in military and trauma settings. Different models of effectiveness research and optimal research designs for conducting trials in acute traumatic pain were also discussed. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to assess the use of clinical detoxification therapies used by licensed naturopathic doctors (NDs) in the United States. Design: This was a qualitative, descriptive, online survey of a convenience sample of NDs. Methods: An online survey was conducted of NDs who were licensed in the United States. Responses were analyzed descriptively regarding the use of clinical detoxification therapies. Respondents were recruited from a membership list provided by the American Association of Naturopathic Physicians, and from alumni e-mail lists of Council of Naturopathic Medical Education accredited naturopathic medical schools. Results: Surveys were sent out to 1442 e-mail addresses (261 were returned to sender); a total of 196 respondents completed the survey (16.6%). Ninety-two percent (92%) of respondents reported using clinical detoxification therapies. Over 75% of respondents utilized detoxification therapies primarily to treat patients for environmental exposures, general cleansing/preventive medicine, gastrointestinal disorders, and autoimmune disease. Regarding methods used, >75% reported using dietary measures, reducing environmental exposures, and using botanicals as detoxification therapies. Eighty-three percent (83%) of NDs surveyed reported using follow-up measurements to determine efficacy of detoxification therapies. The most common were patient symptom questionnaires (66%), patient medical histories (54%), and urinary provocative challenge testing (53%). Conclusions: The majority of NDs responding to this survey reported routine use of clinical detoxification therapies to treat a range of medical conditions utilizing multiple therapeutic approaches. Although the majority of NDs reported using some follow-up measurements after detoxification therapy, few of these are an objective means to determine treatment efficacy. Further research is needed in the field of complementary and alternative medicine clinical detoxification to determine the safety and efficacy of these approaches. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to explore the association between complementary and alternative medicine (CAM) use as reported by youth, and parents' and children's reported quality of life in youth with diabetes. Design: The study design was a cross-sectional survey. Setting: Youth in Washington State participated in the SEARCH for Diabetes in Youth study, a national, multisite epidemiological study designed to assess the prevalence and incidence of diabetes in U.S. youth. Surveys assessing CAM utilization were mailed in January and April 2006. Participants: One thousand four hundred and thirty-nine (1439) youth were mailed a CAM survey. The final sample consisted of 467 youth with both CAM survey results and quality-of-life data. Outcome measures: Difference in mean scores on Pediatric Quality of Life Inventory (PedsQL) between CAM users and nonusers overall, and specific CAM therapies were the outcome measures. Results: Of the 1439 participants approached, 587 (40.8%) returned the CAM survey. In adjusted analyses, children reported any CAM use as associated with more barriers to treatment (difference in mean scores −3.48, 95% confidence interval [CI] −6.65, −0.31). Children following a CAM diet reported higher quality of life (PedsQL Core Total difference 4.01, 95% CI [0.10–7.91]; Core Psychosocial difference was 6.45, 95% CI [1.95 to 10.95]), but those using stress-reduction activities reported poorer quality of life (Diabetes Total difference −4.19, 95% CI [−8.35 to −0.04]). Parent-reported quality of life was lower for children who used “other supplements” (Core Total difference −6.26, 95% CI [−11.29 to −1.24]; Core Psychosocial difference was −5.92, 95% CI [−11.65 to −0.19]). Conclusions: CAM diets were associated with increased quality of life in youth with diabetes, whereas supplement use and stress-reduction activities were associated with decreased quality of life. The temporal sequence between CAM use and quality of life requires further study. [ABSTRACT FROM AUTHOR]

Objectives: Use of complementary and alternative medicine (CAM) by the U.S. population increased significantly in the past 2 decades. To maximize a patient's recovery from a neurosurgical procedure, it is critical that neurosurgeons be aware of the benefits and potential adverse complications of CAM therapies. The survey's purpose was to assess the current patterns of CAM utilization by neurosurgery patients and neurosurgeon knowledge of CAM therapies among Washington State Association of Neurological Surgeons (WSANS) members. Methods: Members of the WSANS were surveyed in 2005. The survey was sent via e-mail and the data were anonymously collected using an online survey tool, Catalyst WebQ. Results: The majority of responses (79%) stated that their neurosurgery practice was ≥75% adults. Acupuncture, herbs, massage therapy, prayer, and yoga were the most common CAM treatments patients used or discussed with their neurosurgeon. Fifty percent (50%) of neurosurgeons discussed the use of acupuncture among their colleagues. Concerning prayer and spirituality, 38% of the surveyed neurosurgeons stated that ≥25% of their patients have disclosed that they pray for their health; 42% stated that spirituality and prayer may affect neurosurgery outcome; and 38% stated that they pray for their patients. Overall, 63% of surveyed neurosurgeons stated that CAM treatments have a role in neurosurgery. Conclusions: The use of CAM may influence neurosurgical care; and the role of spirituality and prayer should be further explored. Because CAM utilization is ubiquitous, open discussion and familiarity with CAM treatments are becoming increasingly important in the field of neurosurgery. [ABSTRACT FROM AUTHOR]

Context: Stimulant medication can effectively treat 60% to 70% of youth with attention-deficit/hyperactivity disorder (ADHD). Yet many parents seek alternative therapies, and Hypericum perforatum (St John's wort) is 1 of the top 3 botanicals used.Objective: To determine the efficacy and safety of H. perforatum for the treatment of ADHD in children.Design, Setting, and Participants: Randomized, double-blind, placebo-controlled trial conducted between March 2005 and August 2006 at Bastyr University, Kenmore, Washington, among a volunteer sample of 54 children aged 6 to 17 years who met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for ADHD by structured interview.Intervention: After a placebo run-in phase of 1 week, participants were randomly assigned to receive 300 mg of H. perforatum standardized to 0.3% hypericin (n = 27) or a matched placebo (n = 27) 3 times daily for 8 weeks. Other medications for ADHD were not allowed during the trial.Main Outcome Measures: Performance on the ADHD Rating Scale-IV (range, 0-54) and Clinical Global Impression Improvement Scale (range, 0-7), and adverse events.Results: One patient in the placebo group withdrew because of an adverse event. No significant difference was found in the change in ADHD Rating Scale-IV scores from baseline to week 8 between the treatment and placebo groups: inattentiveness improved 2.6 points (95% confidence interval [CI], -4.6 to -0.6 points) with H. perforatum vs 3.2 points (95% CI, -5.7 to -0.8 points) with placebo (P = .68) and hyperactivity improved 1.8 points (95% CI, -3.7 to 0.1 points) with H. perforatum vs 2.0 points (95% CI, -4.1 to 0.1 points) with placebo (P = .89). There was also no significant difference between the 2 groups in the percentage of participants who met criteria for improvement (score < or = 2) on the Clinical Global Impression Improvement Scale (H. perforatum, 44.4%; 95% CI, 25.5%-64.7% vs placebo, 51.9%; 95% CI, 31.9%-71.3%; P = .59). No difference between groups was found in the number of participants who experienced adverse effects during the study period (H. perforatum, 40.7%; 95% CI, 22.4%-61.2% vs placebo, 44.4%; 95% CI, 25.5%-64.7%; P = .78).Conclusion: In this study, use of H. perforatum for treatment of ADHD over the course of 8 weeks did not improve symptoms.Trial Registration: clinicaltrials.gov Identifier: NCT00100295. [ABSTRACT FROM AUTHOR]

The article presents a study seeking to determine the efficacy and safety of hypericum perforatum, also known as St. John's wort, as a treatment for attention-deficit hyperactivity disorder (ADHD) in children. The design and setting of the randomized, double-blind study, which involved interviews with a volunteer sample of 54 ADHD children, is described. The outcomes measured included performance of the herbal supplement according to an ADHD rating scale and adverse events. Researchers concluded that hypericum perforatum did not significantly improve ADHD in children over the course of the 8-week trial period.

Objectives: Naturopathic physicians' interest in participating in pediatric observational studies or clinical trials is unknown. Complementary and alternative medicine research may need to be conducted in the settings where these therapies are commonly used to fully understand their effects. Optimally, naturopathic physicians will participate in the research of naturopathic medical practice. A survey was conducted to ascertain naturopathic physicians' interest in participating in pediatric research studies and characteristics of those most interested. Design, setting, and subjects: In July 2004, a survey designed to assess pediatric research interests and a one-dollar incentive was mailed to all Washington state–licensed naturopathic physicians with in-state mailing addresses (n = 513). A second survey and one-dollar incentive were sent to nonresponders in November 2004. Surveys were collected through January 2005. Results: From the 499 surveys delivered as addressed, 251 completed surveys were returned (50.3%). Of the 204 naturopathic physicians in current practice who completed surveys, 59 (28.9%) indicated they would not recommend or advertise an observational, open-label, or placebo-controlled trial to their pediatric patients, and 85 (41.7%) indicated they had no interest in being involved with research studies themselves. Of the 204 respondents in practice, 83 (40.7%) would recommend placebo-controlled trials to their pediatric patients, and 52 (25.5%) were willing to recruit for such a trial in the office. Conclusions: Characteristics of naturopathic physicians most interested in active pediatric research involvement included fewer years in practice, greater number of pediatric patients treated per week, and having shared office space. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine whether Echinacea purpurea given to children for the treatment of acute upper respiratory tract infection (URI) was effective in reducing the risk of subsequent URI. Design: This was a secondary analysis of data from a randomized, double-blind, placebo-controlled trial of Echinacea for the treatment of URI in children. Setting: The study was conducted as a joint project between the Puget Sound Pediatric Research Network (Seattle, WA) and Bastyr University (Kenmore, WA). Participants: A total of 524 children ages 2 to 11 years were enrolled in the study. Intervention: Children were monitored for URIs over a 4-month observation period during the fall/winters of 2000-2001 and 2001-2002. At entry the children were randomized to receive Echinacea or placebo to treat acute URIs during the observation period. Main outcome measures: The occurrence of a second URI and the number of days between the end of the first URI and the start of the second URI was ascertained. Survival and Cox regression analyses were used to determine whether children who took Echinacea for their URIs were less likely to develop subsequent URIs. Results: Among the 401 children with at least one URI treated with study medication, 69.2% of those receiving placebo developed a second URI versus 55.8% of those who received Echinacea. Use of Echinacea was associated with a 28% decreased risk of subsequent URI (p = 0.01, 95% confidence interval 8%-44% decreased risk). Conclusions: Echinacea purpurea may be effective in reducing the occurrence of subsequent URIs in children. However this finding needs to be replicated in a URI prevention trial. [ABSTRACT FROM AUTHOR]

When students take their first upper division mathematics course after an introduction to proof course, they are often over- whelmed by the prospect of writing in a mathematics course. In mathematics, unlike other disciplines, students are very seldom asked to respond via writing to a reading assignment, to write an essay about a topic they have always used their intuition to explain, or to fully research a mathematics topic and report on it to their peers. This paper will highlight the ways in which writing, reading, and group work can be used to develop skills in geometry in one semester. [ABSTRACT FROM AUTHOR]

Context: Echinacea is a widely used herbal remedy for treatment of upper respiratory tract infections (URIs). However, there are few data on the efficacy and safety of echinacea in treating URIs in children. Objectives: To determine if Echinacea purpurea is effective in reducing the duration and/or severity of URI symptoms in children and to assess its safety in this population. Design, Setting, and Participants: Randomized, double-blind, placebo-controlled trial of healthy children 2 to 11 years old recruited from a regional practice-based network and an alternative medical center in 4-month periods from 2000 through 2002. Interventions: Study patients were randomized to receive either echinacea or placebo for up to 3 URIs over a 4-month period. Study medication was begun at the onset of symptoms and continued throughout the URI, for a maximum of 10 days. Main Outcome Measures: Primary outcomes were duration and severity of symptoms and adverse events recorded by parents; secondary outcomes included peak severity of symptoms, number of days of peak severity, number of days of fever, and a global assessment of severity of symptoms by parents of study children. Results: Data were analyzed on 707 URIs that occurred in 407 children, including 337 URIs treated with echinacea and 370 with placebo. There were 79 children who completed their study period without having a URI. The median duration of URIs was 9 days (95% confidence interval, 8-10 days); there was no difference in duration between URIs treated with echinacea or placebo (P = .89). There was also no difference in the overall estimate of severity of URI symptoms between the 2 treatment groups (median, 33 in both groups; P = .69). In addition, there were no statistically significant differences between the 2 groups for peak severity of symptoms (P = .68), number of days of peak symptoms (1.60 in the echinacea group and 1.64 in the placebo group; P = .97), number of days of fever (0.81 in the echinacea group vs 0.64 in the placebo group; P = .09), or parental global assessment of severity of the URI (P = .67). Overall, there was no difference in the rate of adverse events reported in the 2 treatment groups; however, rash occurred during 7.1% of the URIs treated with echinacea and 2.7% of those treated with placebo (P = .008). Conclusions: Echinacea purpurea, as dosed in this study, was not effective in treating URI symptoms in patients 2 to 11 years old, and its use was associated with an increased risk of rash. [ABSTRACT FROM AUTHOR]

The essay explores the ways in which Patricia Nell Warren's The Fancy Dancer (1976) employs Roman Catholic sacraments to depict the developing sexuality of a young gay priest. The essay explores the parallels between sacramental spiritual development and the individual and communal markers of a burgeoning gay or lesbian identity. Additionally, the novel's connections between conversion narratives and coming-out narratives are examined. The essay argues that Warren, in using the rhetoric, symbols, and models of the Church differently, disrupts the narrow epistemology underlying Christianity. Finally, novels such as Warren's suggest that gay and lesbian authors can adapt elements of Christianity while undermining its oppressive presumptions, and establishing a liberatory rhetoric that maintains the intelligibility and recognizability of familiar Christian models. [ABSTRACT FROM AUTHOR]

Presents a reply to letters to the editor on the use of echinacea for treating colds in children.

A letter to the editor is presented in response to the article "Quality of Efficacy Research in Complementary and Alternative Medicine" by E. Chan in a previous issue.