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Background Depression is a common mental health condition that affects 1 in 8 males each year, especially young adults. Young adulthood offers an opportunity for early dietary interventions, with research suggesting that a Mediterranean diet (MD) could be beneficial in treating depression. Objectives This study aimed to determine if an MD can improve depressive symptoms in young males with clinical depression. Methods A 12-wk, parallel-group, open-label, randomized controlled trial was conducted to assess the effect of an MD intervention in the treatment of moderate to severe depression in young males (18–25 y). Befriending therapy was chosen for the control group. Assessments were taken at baseline, week 6, and week 12. MD adherence was measured with the Mediterranean Diet Adherence Score (MEDAS). The primary outcome measure was the Beck Depression Inventory Scale—version II (BDI-II) and secondary outcome was quality of life (QoL). Results A total of 72 participants completed the study. After 12 wk, the MEDAS scores were significantly higher in the MD group compared with the befriending group (mean difference: 7.8; 95% CI: 7.23, 8.37; P  < 0.001). The mean change in BDI-II score was significantly higher in the MD group compared with the befriending group at week 12 (mean difference: 14.4; 95% CI: 11.41, 17.39; P  < 0.001). The mean change in QoL score was also significantly higher in the MD group compared with the befriending group at week 12 (mean difference: 12.7; 95% CI: 7.92, 17.48; P  < 0.001). Conclusions Our results demonstrate that compared with befriending, an MD intervention leads to significant increases in MEDAS, decreases in BDI-II score, and increases in QoL scores. These results highlight the important role of nutrition for the treatment of depression and should inform advice given by clinicians to this specific demographic population. The trial was registered with Australia and New Zealand Clinical Trials Registry (trial ID ACTRN12619001545156) and has also been registered with the WHO International Clinical Trials Registry Platform (Universal Trial Number U1111-1242-5215). [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ctim.2007.06.002 Byline: Mavourneen Casey (a), Jon Adams (b), David Sibbritt (c) Keywords: Herbal medicine; Prescription; Concurrent conventional medical practice Abstract: To examine the clinical practices and perceptions of herbalists providing patient care concurrently with conventional medical practice. Author Affiliation: (a) School of Applied Science, Faculty of Science and IT, University of Newcastle, Ourimbah 2258, Australia (b) Epidemiology and Social Medicine Division, School of Population Health, University of Queensland, Australia (c) Centre for Clinical Epidemiology and Biostatistics, School of Medical Practice and Population Health, Faculty of Health, University of Newcastle, Level 3 DMB, Royal Newcastle Hospital, Newcastle 2300, Australia Article Note: (footnote) [star] This project has been approved by the University of Newcastle, Human Research Ethics Committee, Approval No. H-(677-1003).

Work-related injuries constitute a significant proportion of osteopaths' practice. This study was designed to determine the practitioner and practice characteristics of osteopaths who treat people with work-related injuries and to identify the impact of workers' compensation scheme status on the use of osteopathic medicine. A cross-sectional survey was distributed to a nationally-representative sample of 992 Australian osteopaths. Multivariate logistic regression modelling was performed to identify the practitioner and practice characteristics of osteopaths that were statistically significantly associated with the treatment of work-related injuries. A total of 847 osteopaths (86%) at least sometimes treated people with work-related injuries within the previous 12-months. One hundred and three participating osteopaths indicated they often treated people with work-related injuries who were covered by a workers' compensation scheme and 341 participating osteopaths indicated they often treated people with work-related injuries who were not covered by a workers' compensation scheme. Osteopaths who often treated work-related injuries were also more likely to often treat people with sports-related injuries, often treat people with traffic-related injuries, and/or often discuss medications with patients. A large proportion of Australian osteopaths treat people with work-related injuries. Further examination of osteopathic medicine use for work-related injuries is warranted. • More than 85% of osteopaths at least sometimes treated people with work-related injuries within the previous 12 months. • A total of 35% of osteopaths often treated injured workers who were not covered by the Workers' Compensation Scheme. • Numerous variations exist in osteopathic treatments for injured workers with and without a Workers' Compensation Scheme. [ABSTRACT FROM AUTHOR]

Massage is a popular form of health care used among women, yet little is known about the characteristics of women who use massage therapy and the rationale for its use. This study reports the prevalence and characteristics of young and middle-aged Australian women who consulted a massage therapist. The study analysed data from the Australian Longitudinal Study on Women's Health; a nationally-representative sample of Australian women. The data from 7,993 young, and 9,102 middle-aged women were included in the analyses and massage use was compared against measures of health status, health care utilisation, and demographics. Prevalence of consultation with a massage therapist in the previous 12 months was 42.4% in young women and 25.2% in middle-aged women. Women who consulted a massage therapist were more likely to consult other complementary medicine practitioners and/or use self-prescribed complementary medicine. Both young and middle-aged women were more likely to consult a massage therapist if they experienced musculoskeletal problems; however less likely, with chronic disease such as diabetes and hypertension. Despite large numbers of young and middle-aged Australian women consulting a massage therapist, no Australian studies investigate the prevalence of massage consultations and report correlations with characteristics relevant to demographic, health status and health service data. Our findings highlight the need for further investigation of women's choices relevant to the use of massage therapy. Such research could shape the future of women's health care by providing insight into women's decision making around massage therapy, conventional treatment and healthcare utilisation. [ABSTRACT FROM AUTHOR]

Background and Aims: Most studies measure baseline diet quality exclusively and hence the impact of longitudinal changes in dietary intake in relation to weight change is not considered. Therefore, this study aimed to examine whether change in diet quality over nine-years was associated with weight change over the same period in mid-age Australian women.Methods and Results: Healthy mid-age (45-49 years) women from the Australian Longitudinal study on Women's Health (ALSWH) were eligible a valid total energy intake (TEI) was reported at baseline (n = 2381), determined using Goldberg cut-offs. Diet quality was measured by the Australian Recommended Food Score (ARFS) using data derived from a validated food frequency questionnaire. Multiple linear regressions were used to evaluate relationships between change in diet quality and weight in mid-age women (n = 1999). Women in the highest tertile of ARFS change improved diet quality [mean ± SD] [7 ± 4 points], while those in the lowest [-9 ±5 points] and middle [-1±2 points] tertiles had worse diet quality at follow-up. Overall, mean weight gain was 2.3 ± 7.2 kg over nine years. Those in the highest tertile of ARFS change gained significantly less weight, compared to the lowest tertile; β = -1.2 kg [95% CI: -2.31, -0.11; p = 0.03] after adjustment for changes in confounders and baseline weight, baseline ARFS, and total energy intake.Conclusions: Improving diet quality could be an important strategy for promoting modest weight loss and potentially contribute to preventing weight gain in mid-age women, which is important for metabolic health. [ABSTRACT FROM AUTHOR]

Background: Approximately one in four adults do not meet the World Health Organisation physical activity recommendations. While health promotion (i.e., physical activity) is common within chiropractic settings, little is known about chiropractors discussing this public health issue with their patients. The aim of our study is to examine the prevalence and characteristics of Australian chiropractors who frequently discuss patient physical activity.Methods: A national cross-sectional survey of chiropractors focusing upon practitioner characteristics, practice settings and clinical management characteristics. Regression analyses were conducted on 1924 survey respondents to identify factors associated with practitioners who frequently discuss physical activity with patients.Results: Eighty-five percent of Australian chiropractors reported 'often' discussing physical activity as part of their patient management. The strongest factors associated with chiropractors who frequently discuss physical activity obtained from the multivariate analysis include: often discussing occupational health and safety (odds ratio [OR] = 6.10; 95%CI: 3.88, 9.59), often discussing diet/nutrition (OR = 4.56; 95%CI: 3.12, 6.66), often discussing smoking/drugs/alcohol (OR = 4.41; 95%CI: 2.06, 9.40), often use of specific exercise therapy/rehabilitation/injury taping (OR = 3.76; 95%CI: 2.62, 5.39) and often caring for athletes or sports people (OR = 2.18; 95%CI: 1.56, 3.06) within their practice setting.Conclusion: Discussing physical activity is a frequent feature of patient management among most chiropractors in Australia. The association between these practitioners and discussion of other costly public health burdens could suggest chiropractors have a valuable role to play in chronic disease prevention. Given the growing need for practitioner-led promotion of patient physical activity further research examination of the role and contribution of chiropractors in promoting this important public health topic among patients and communities is needed. [ABSTRACT FROM AUTHOR]

Abstract Background and purpose Yoga and meditation are predominantly utilised by healthy well-educated young women, but little is known about utilisation by older chronically ill women. Therefore, the purpose of this study was to investigate the characteristics of yoga and meditation use among middle-to-higher aged Australian women with chronic conditions. Materials and methods This is a sub-study of the 45 and Up Study including 1925 Australian women aged 53–95 years diagnosed with chronic conditions (asthma, depression, diabetes, osteoarthritis, and osteoporosis). Information on yoga and meditation use frequencies (categories: 'no yoga', 'at least once daily', 'at least once weekly', and 'at least once monthly'), self-perceived effectiveness and communication with health care providers were assessed via self-report. Logistic regression analyses were conducted to identify independent predictors of yoga and meditation use, using SPSS 24.0. Results Overall 6.8% and 10.7% of women reported the use of yoga and meditation respectively. Meditation was rarely practiced supervised (11.7%), compared to significant higher rates in yoga (53.2%). Predictors for yoga and meditation use were marital status (married/in relationship > not married/in relationship), higher health related hardiness, and higher education, whereas obesity, and diabetes decreased likelihood of use. While the majority found yoga and meditation helpful for their condition, the use was rarely monitored by or discussed with health care practitioners. Conclusion This study finds that yoga and meditation are used by middle-to-higher aged Australian women with chronic illnesses. The lack of communication with health care providers is concerning and might hinder coordinated and effective health care around chronic illness. Further research is necessary to help understand possible concurrent health care use and thereby help inform safe, effective and coordinate health seeking amongst those with chronic illness. Highlights • Yoga and meditation are used by middle-to-older aged Australian women with chronic illnesses. • Older women using yoga or meditation rarely communicate this with their health care providers. • High levels of health hardiness are associated with higher use of yoga and meditation. [ABSTRACT FROM AUTHOR]

Objectives: To explore the characteristics of the Australian osteopathy workforce who participate in the management of older patients with musculoskeletal complaints.Design: Secondary analysis of a cross-sectional survey of osteopaths.Setting: The Osteopathy Research and Innovation Network (ORION), an Australian practice-based research network.Main Outcome Measures: The demographic, practice and treatment characteristics of osteopaths who identify as 'always'or 'often' treating patients aged 65 years or over.Results: Over half (58%) of total participants (n = 992) indicated often treating older people and this was associated with referral patterns with other health professionals and a non-urban practice location. Osteopaths providing care to older people were more likely to discuss diet/nutrition and medications, and provide pain counselling. Osteopaths who treated older adults were more likely to treat shoulder musculoskeletal disorders, degenerative spine disorders, chronic or persistent pain, and tendinopathies.Conclusions: A substantial proportion of Australian osteopaths treat older adults frequently. The potential value and impact of osteopathy in managing the health needs of an ageing population warrants close examination from both researchers and policy makers. [ABSTRACT FROM AUTHOR]

Objective: Examine the generational differences in complementary medicine (CM) utilisation between young women from the X and Millennial generations.Design: Secondary analysis of two cross-sectional surveys from the Australian Longitudinal Study on Women's Health (ALSWH).Setting: Australia.Main Outcome Measures: Differences between young Generation X women (surveyed 1996; aged 18-23 years), and Millennial women (surveyed 2014; aged 19-24 years) regarding consultations with CM practitioners, sociodemographic characteristics, and health. Predictors for CM consultations were analysed via logistic regression analyses.Results: Of the 14,247 Generation X women, 19.4% reported consulting CM, compared to 26.8% of the 11,344 Millennial women. CM consultations was predicted in both cohorts by higher age, education beyond primary school, non-urban (vs. urban) residence, and frequent back pain or headaches. Obesity and regular smoking predicted non-use in both. Significant cohort differences were found in physical activity levels (moderate/high levels associated with increased CM consultations in Millennial, but not Generation X women), and health status (Generation X women reporting fair-poor health were more likely to consult CM practitioners, while Millennial women reporting good health were less likely to do so, compared to women with very good/excellent health).Conclusions: The increase in CM utilization among young Australian women from Generation X compared to the Millennial generation could indicate different health consumer patterns for future middle-aged and older adult Australian women. Further increases in CM usage may be observed as current young women age into characteristics traditionally linked with higher CM use such as worsening health status and increased disposable income. [ABSTRACT FROM AUTHOR]

Aims: To provide a critical analysis of peer-reviewed literature reporting research from practice-based research networks (PBRNs) relating to complementary and alternative medicine (CAM).Methods: A comprehensive literature search of peer-reviewed literature reporting PBRN research focusing upon CAM was conducted in PubMed, Ovid Medline, EMBASE, and CINAHL from their inceptions to June 2017. PBRN registry and websites of relevant PBRNs were also searched for further information. With regards to the nested PBRN studies included in our review, no study design restrictions were imposed and both empirical research and relevant methodologically-focused manuscripts were included. Methodological quality was evaluated via a number of established tools.Results: A total of 51 articles reporting upon CAM research in PBRNs including six articles outlining CAM-focused PBRN establishment were included in the review. The findings of the literature were categorised as either: health services research (including work examining characteristics of patients and practices, doctor-patient communication, and CAM prevalence); effectiveness/safety research; or feasibility research. While 19 studies from non-CAM focused PBRNs tended to report on CAM prevalence and doctor-patient communication about CAM use, 26 articles from CAM-focused PBRNs reported on the characteristics of CAM users, practice patterns, and effectiveness/safety of CAM practice.Discussion and Conclusion: PBRNs - both CAM-focused and non-CAM focused - have provided a useful platform for research investigations around a number of core CAM-related issues. Given the increasing popularity of CAM use in healthcare and the identified benefits of practice-relevant research, further in-depth CAM research nested within PBRN designs is warranted. [ABSTRACT FROM AUTHOR]

Objectives: Little is known about women's use of health services affected by headache or migraine during pregnancy. This paper directly addresses the research gap reporting on the healthcare utilization among Australian pregnant women experiencing headache or migraine.Design and Setting: In this retrospective observational study, data on 1,835 Australian pregnant women were obtained from the nationally-representative Australian Longitudinal Study on Women's Health. Information on quality of life and health seeking behaviors regarding conventional medicine and complementary and alternative medicine providers was identified among these participants. Factors associated with healthcare use were analyzed using regression analyses.Results: A total of 16% of the pregnant women surveyed experienced headache or migraine, and over 20% sought help from more than two types of healthcare practitioners for their headache or migraine. General practitioners (37.8%) were the most commonly consulted providers of pregnant women for their headache or migraine. Women with headache or migraine during pregnancy had worse health-related quality of life than those without. Education level and private health insurance status of pregnant women are the predictors of the use of healthcare practitioners for their management of headache or migraine (both p < 0.05).Conclusions: Headache or migraine during pregnancy significantly impacts upon pregnant women's quality of life. The use of multiple healthcare practitioners, including conventional medicine and complementary and alternative medicine practitioners, highlights the need for further research investigating health services utilization of pregnant women with headache or migraine in different severity and frequency to help inform effective and safe treatment. [ABSTRACT FROM AUTHOR]

Objectives: A range of health-care professionals including chiropractors provide treatment for sports-related health problems. This study reports analyses from the first national workforce survey to determine practitioner and practice-related factors associated with the frequent treatment of athletes or sports people by Australian chiropractors.Design and Setting: A 21-item questionnaire collecting information pertaining to practitioner and practice-related characteristics was distributed to all Australian registered chiropractors, as part of the Australian Chiropractic Research Network (ACORN) project and attracted a response rate of 43% (n = 2005). Statistical analyses compared the frequency of treating athletes or sports people against a wide range of relevant practitioner and practice characteristics.Results: Of the respondents, 49.5% (n = 936) reported frequently treating athletes or sports people, and these chiropractors were more likely to be male as well as report more patient care hours and patient visits per week than those chiropractors who did not frequently treat athletes or sports people. Chiropractors who frequently treat athletes or sports people were also more likely to perform multi-modal management, have multi-disciplinary practitioner relations, use diagnostic equipment and discuss nutrition and medication use as part of their patient care than those chiropractors who did not frequently treat athletes or sports people.Conclusions: Nearly half of participating Australian chiropractors treat athletes or sports people frequently. The current and potential role of chiropractors in sports medicine appears significant. Further research is needed to examine the role, practices and outcomes of such chiropractic care helping to, provide treatment and policy development in this area of clinical management. [ABSTRACT FROM AUTHOR]

Background The comparative safety of different birth settings is widely debated. Comparing research across high-income countries is complex, given differences in maternity service provision, data discrepancies, and varying research techniques and quality. Studies of births planned at home or in birth centres have reported both better and poorer outcomes than planned hospital births. Previous systematic reviews have focused on outcomes from either birth centres or home births, with inconsistent attention to quality appraisal. Few have attempted to synthesise findings. Objective To compare maternal and perinatal outcomes from different places of birth via a systematic review of high-quality research, and meta-analysis of appropriate data (Prospero registration CRD42016042291). Design Reviewers searched CINAHL, Embase, Maternity and Infant Care, Medline and PsycINFO databases to identify studies comparing selected outcomes by place of birth among women with low-risk pregnancies in high-income countries. They critically appraised identified studies using an instrument specific to birth place research and then combined outcome data via meta-analysis, using RevMan software. Findings Twenty-eight articles met inclusion criteria, yielding comparative data on perinatal mortality, mode of birth, maternal morbidity and/or NICU admissions. Meta-analysis indicated that women planning hospital births had statistically significantly lower odds of normal vaginal birth than in other planned settings. Women experienced severe perineal trauma or haemorrhage at a lower rate in planned home births than in obstetric units. There were no statistically significant differences in infant mortality by planned place of birth, although most studies had limited statistical power to detect differences for rare outcomes. Differences in location, context, quality and design of identified studies render results subject to variation. Conclusions and implications for practice High-quality evidence about low-risk pregnancies indicates that place of birth had no statistically significant impact on infant mortality. The lower odds of maternal morbidity and obstetric intervention support the expansion of birth centre and home birth options for women with low-risk pregnancies. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to provide an empirical examination of how complementary medicine practice in Australia is actually regulated under the current national registration model.Methods: Data was obtained from Australian Health Practitioner Regulation Agency (AHPRA) Annual Reports for the years 2011/12-2014/15 and supplemented by the Chinese Medical Registration Board of Victoria (CMRBV) Annual Reports in 2011/12 for Chinese Medicine complaints. The data analysed includes complaint statistics, stage of closure of complaints and the outcome of complaints concerning Chinese medicine, chiropractic and osteopathy under the National Law.Results: During 2014-2015 the number of complaints per 100 registrants for was highest for the medical board (4.4), while much lower for the chiropractic (1.5), osteopath (0.7) and Chinese medicine (0.5) boards. For conventional boards, 58% of complaints were closed at the assessment stage, while 57%, 29% and 16% of complaints to the osteopath, Chinese medicine and chiropractic boards respectively were closed at the assessment stage. The decision to suspend or cancel registration of health professionals was 17% from the Chinese medicine board, 14% from the Osteopathy Board, 1.5% from the chiropractor board and 0.6% from the medical board.Conclusion: It appears that complementary medicine practitioner regulation works at least as well as conventional regulation, and at most complementary medicine boards take a stricter interpretation of misconduct though more research would need to be undertaken to state this definitively. Our findings indicate that the public are using the statutory complaint mechanisms available to them with respect to the three CM groups. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine whether the use of complementary medicine (CM) is associated with body satisfaction and weight management methods in Australian women.Methods: Women aged 34-39 years from the Australian Longitudinal Study on Women's Health were surveyed regarding satisfaction with their body weight and shape, and the use of weight management methods. Associations with CM use were analysed using logistic regression modelling.Results: Women using CM less likely wanted to lose weight; and were more likely to cut down on fats and/or sugars, use low glycaemic diets, diet books and 'other' methods (OR: 1.33-2.83) compared to CM non-users. Women using herbal medicine products 'sometimes' were more likely to use meal replacements/slimming products (OR: 1.50-1.67) compared to non-users.Discussion: Australian women using CM are more likely to be satisfied with their body weight and shape, and to use a range of weight management approaches compared to CM non-users. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the influence of work-related characteristics, health, health behaviours and symptoms on ingestible biologically-based Complementary and Alternative Medicine (CAM) use within the Australian nursing and midwifery workforce.Background: CAM use is widespread worldwide, but there is little research into nurses' and midwives' personal use of ingestible CAM in Australia.Methods: An online survey in 2014-15 used validated instruments and items to examine use of ingestible biologically-based CAM (herbs, foods and vitamins, minerals, amino acids, enzymes and other supplements), and the health and work-related characteristics of 5041 nurses and midwives recruited through the New South Wales Nurses and Midwives Association and professional networks.Results: A small proportion of nurses (6.8%) identified as personal CAM users. Most were female, older, worked in foundational roles (frontline Registered and Enrolled Nurses/Midwives) and used one CAM, most commonly a multivitamin, although Vitamin D, Fish Oil, Calcium and Glucosamine±Chondroitin were also common. In comparison to non-users, CAM users were less likely to take sick days or indulge in risky drinking, but more likely to be symptomatic (with stiff joints, bodily/joint pain, severe tiredness, allergies, indigestion/heartburn), diagnosed with osteoarthritis and to adhere to healthy diet recommendations.Conclusions: Findings showed a credible pattern of front line workers with physically demanding workloads that impact their physical health and are linked to frequent symptoms, using CAM treatments and achieving some success in being able to continue working and avoid sickness absence. Further investigation is warranted to protect and maintain the health of the nursing and midwifery workforce. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relationship between yoga/meditation practice and health behavior in Australian women.Methods: Women aged 19-25years, 31-36years, and 62-67years from the Australian Longitudinal Study on Women's Health (ALSWH) were surveyed regarding smoking, alcohol or drug use, physical activity and dietary behavior; and whether they practiced yoga/meditation on a regular basis. Associations of health behaviors with yoga/meditation practice were analyzed using multiple logistic regression modelling.Results: 11,344, 8200, and 9151 women aged 19-25years, 31-36years, and 62-67years, respectively, were included of which 29.0%, 21.7%, and 20.7%, respectively, practiced yoga/meditation. Women practicing yoga/meditation were significantly more likely to report at least moderate physical activity levels (OR=1.50-2.79), to follow a vegetarian (OR=1.67-3.22) or vegan (OR=2.26-3.68) diet, and to report the use of marijuana (OR=1.28-1.89) and illicit drugs in the last 12 months (OR=1.23-1.98).Conclusions: Yoga/meditation practice was associated with higher physical activity levels, a higher likelihood of vegetarian or vegan diet use, and a higher likelihood of drug use. While health professionals should keep the potential vulnerability of yoga/meditation practitioners to drug use in mind, the positive associations of yoga/meditation with a variety of positive health behaviors warrant its consideration in preventive medicine and healthcare. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between health status and health service utilization (including conventional and complementary and alternative medicine [CAM]) accessed by women experiencing urinary incontinence (UI). Although a high number of younger women report symptoms of UI, such as leaking urine, only a small proportion seek help for these symptoms.Materials and Methods: The Australian Longitudinal Study on Women's Health is a large nationally representative study that investigates the health and well-being of women. The 2 most recent surveys (2006 and 2009) of the young cohort (women aged 28-33 and 31-36 respectively) were analyzed.Results: The presence of UI was 8.5% in 2006 (n = 859) and 23.3% in 2009 (n = 1878), whereas the percentage of women who sought help for their UI was 18.6% (n = 160) and 2.2% (n = 182) respectively. Women with UI had poorer health compared with women without UI (P < .005), and women who sought help for their symptoms had poorer physical functioning than women who did not (P < .005). Women who sought help were greater users of conventional and CAM health services (P < .005), including a general practitioner, specialist, hospital doctor, physiotherapist, and naturopath.Conclusion: UI is relatively common in younger women. However, many do not seek help. Of the women who do seek care, a large number visit CAM professionals as well as conventional medical professionals, despite a lack of research evaluating the efficacy of CAM treatment. Research is needed to explore CAM practitioner approaches to the treatment of UI and to evaluate the efficacy of these treatments. [ABSTRACT FROM AUTHOR]

Background Little research has been conducted regarding the comprehensive health service utilisation in constipation care. This study investigates the comprehensive health service utilisation amongst Australian women with constipation. Methods This study draws upon data from the Australian Longitudinal Study on Women's Health. A total of 8074 young women were asked about their frequency of constipation, measures of quality of life, and use of a range of health services and self-prescribed treatments via two postal surveys conducted in 2006 and 2009, respectively. Results The prevalence of constipation was 18.5% amongst women in 2009. Constipated women had poorer quality of health than women without constipation. Women who sought help for constipation were more likely to visit multiple groups of conventional and complementary health practitioners compared to women who did not experience constipation ( p < 0.005). However, women were less likely to visit a specialist for the management of constipation over time (2006 to 2009). There was an increase in the proportion of women with constipation who self-prescribed vitamins/minerals over time ( p < 0.001). Conclusion Although only 4.5% of women sought help for their constipation, given the increasing use of multiple health services across time, more studies are required regarding the optimal treatment in constipation care. [ABSTRACT FROM AUTHOR]

Background Emerging evidence suggests that some people living with non-communicable diseases (NCDs) have integrated energy healing into their self-management strategy, however little is known about its efficacy. Purpose To identify energy healing interventions that impacted positively on the symptom management outcomes for patients living in the community with various NCDs. Methods A systematic review of energy healing interventions for the management of non-communicable disease related symptoms, conducted between 01 January 2000 and 21 April 2015, published in an English peer-reviewed journal. This review conforms to the PRISMA statement. Results Twenty seven studies were identified that evaluated various energy healing interventions involving 3159 participants. Thirteen of the energy healing trials generated statistically significant outcomes. Conclusions Energy healing has demonstrated some improvement in illness symptoms, however high level evidence consistently demonstrating efficacy is lacking. Further more robust trials are required to better understand which elements of energy healing interventions are associated with positive outcomes. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this paper is to report on the recruitment and promotion strategies employed by the Australian Chiropractic Research Network (ACORN) project aimed at helping recruit a substantial national sample of participants and to describe the features of our practice-based research network (PBRN) design that may provide key insights to others looking to establish a similar network or draw on the ACORN project to conduct sub-studies. Methods The ACORN project followed a multifaceted recruitment and promotion strategy drawing on distinct branding, a practitioner-focused promotion campaign, and a strategically designed questionnaire and distribution/recruitment approach to attract sufficient participation from the ranks of registered chiropractors across Australia. Results From the 4684 chiropractors registered at the time of recruitment, the project achieved a database response rate of 36% (n = 1680), resulting in a large, nationally representative sample across age, gender, and location. This sample constitutes the largest proportional coverage of participants from any voluntary national PBRN across any single health care profession. Conclusions It does appear that a number of key promotional and recruitment features of the ACORN project may have helped establish the high response rate for the PBRN, which constitutes an important sustainable resource for future national and international efforts to grow the chiropractic evidence base and research capacity. Further rigorous enquiry is needed to help evaluate the direct contribution of specific promotional and recruitment strategies in attaining high response rates from practitioner populations who may be invited to participate in future PBRNs. [ABSTRACT FROM AUTHOR]

Summary Background The use of complementary and alternative medicine (CAM) is commonplace in Australia with massage being a popular CAM modality. Methods This is a sub-study from the Australian Longitudinal Study on Women's Health (ALSWH). A total of 2120 mid-age (56–61 year old) women who consulted a CAM practitioner were invited to participate in this study. The Short-Form (SF-36) questionnaire was used to measure women's health-related quality of life. Results A total of 1800 women returned the questionnaire generating a response rate of 85.0%. Overall, 912 (50.7%) women visited a massage therapist in the previous 12 months. Women with lower quality of life scores in terms of bodily pain (p = 0.012) and/or emotional health (p = 0.029) were more likely to consult a massage therapist than those with higher scores. Conclusion The implications of these associations are important for informing healthcare providers in providing effective and coordinated care for patients with pain and mood symptoms. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence and characteristics of users of prayer or spiritual healing among Australian women aged 31-36 years.Design and Setting: This cross-sectional study was conducted as a part of the Australian Longitudinal Study on Women's Health (ALSWH). The sample used in the current sub-study were participants from the 'young' cohort (1973-78) (n=8180) aged between 31 and 36 years.Main Outcome Measure: Use of prayer or spiritual healingResults: Prayer or spiritual healing was used on a regular basis by 20% of women aged between 31 and 36 years in 2009. Women who had symptoms of chronic illnesses (p=0.001), women who had never smoked (p=0.001) and women who used other forms of CAM (p<0.001) were significantly more likely to use prayer or spiritual healing.Conclusion: A significant proportion of women use prayer or spiritual healing on a regular basis. Further research is required to better understand their rationale for using prayer or spiritual healing and its perceived impact on health related outcomes and general well-being. [ABSTRACT FROM AUTHOR]

Introduction: Falls are the leading cause of injuries in women across all ages. While yoga has been shown to increase balance, it has also been associated with injuries due to falls during practice. This study aimed to analyse whether regular yoga or meditation practice is associated with the frequency of falls and fall-related injuries in upper middle-aged Australian women.Methods: Women aged 59-64 years from the Australian Longitudinal Study on Women's Health (ALSWH) were queried regarding falls and falls-related injuries; and whether they regularly practiced yoga or meditation. Associations of falls and falls-related injuries with yoga or meditation practice were analysed using chi-squared tests and multiple logistic regression modelling.Results: Of 10,011 women, 4413 (44.1%) had slipped, tripped or stumbled, 2770 (27.7%) had fallen to the ground, 1398 (14.0%) had been injured as a result of falling, and 901 (9.0%) women had sought medical attention for a fall-related injury within the previous 12 months. Yoga or meditation was practiced regularly by 746 (7.5%) women. No associations of falls, fall-related injuries and treatment due to falls-related injury with yoga or meditation practice were found.Discussion: No association between yoga or meditation practice and falls or fall-related injuries have been found. Further studies are warranted for conclusive judgement of benefits and safety of yoga and meditation in relation to balance, falls and fall-related injuries. [ABSTRACT FROM AUTHOR]

Background Common discomforts of pregnancy experienced in the lower extremity include sciatica, leg cramps and varicose veins. Whilst research attention has focused on aetiology and outcomes, the health service utilisation of pregnant women suffering from these complaints has been largely overlooked. Aim To examine the health status and health service utilisation profile of pregnant women experiencing sciatica, leg cramps or varicose veins. Methods Linear and logistic regression was applied to a cross-sectional survey of a pregnant women drawn from the 1973 to 1978 cohort (aged 31–36 years in 2009), of the Australian Longitudinal Study on Women's Health ( n = 1835). Participant's demographics, health status and health service utilisation were compared for all three complaints based upon three subgroups (yes, sought help; yes, did not seek help; no). Findings A number of women experienced sciatica (22.1%), leg cramps (18.2%) or varicose veins (9.4%). Of these, a greater proportion of women with sciatica (79.3%) or varicose veins (71.5%) sought help for their condition compared with women with leg cramps (46.7%). Comparisons between women with the conditions of interest who did seek help and those who did not only found that women with a university degree were 0.29 (95% CI: 0.10, 0.85) times less likely to seek help for their condition compared to women with a school only education. Conclusion Further research examining all health seeking behaviour and treatment use of pregnant women who experience lower extremity problems is required in order to facilitate safe, effective and coordinated maternity care to further support these women during pregnancy. [ABSTRACT FROM AUTHOR]

Summary Background/aim The use of complementary medicine (CM) is common during pregnancy with visits to osteopathic practitioners growing in recent years. This study was conducted to investigate the prevalence and characteristics of women who consult osteopathic practitioners during pregnancy. Method The study sample was obtained via the Australian Longitudinal Study on Women's Health (ALSWH). The women answered questions about consultations with osteopathic practitioners, pregnancy-related health concerns and attitudes to CM use. Results A total response rate of 79.2% (1835) was obtained. Of these, 104 women (6.1%) consulted with an osteopath during pregnancy for a pregnancy-related health condition. Women were more likely to consult an osteopath if they suffered from back pain, sadness, weight management issues, or had a history of retained placenta. Conclusion Women are visiting osteopaths for help with common pregnancy health complaints, highlighting the need for research to evaluate the safety, clinical and cost effectiveness of osteopathy in pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To analyze back pain sufferers' attitudes toward consultations with complementary and alternative medicine (CAM) practitioners and self-prescribed CAM products.Methods: A cross-sectional survey of a nationally representative sample of Australian women aged 60-65 years.Results: A significant number of women with back pain consulted a massage therapist (41.4%, n=578), a chiropractor (37.3%, n=488), an acupuncturist (13.3%, n=174), used self-prescribed supplements (59.2%, n=776), vitamins/minerals (45.2%, n=592) and/or herbal medicines (13.1%, n=172). Women who perceived CAM as providing greater control over their body/health were more likely to have consulted a chiropractor (OR=4.21; 95% CI; 2.16, 8.19) and/or self- prescribed supplements (OR=2.38; 95% CI: 1.05, 3.49) than those who did not perceive CAM as providing greater control over their body/health. Women who perceived CAM as natural (OR=1.56; 95% CI: 1.02, 2.37) or promoting a holistic approach to health (OR=2.73; 95% CI: 1.60, 4.64) were more likely to have self-prescribed vitamins/minerals than those who did not perceive CAM as natural and promoting a holistic approach to health. Women who expressed that knowledge about evidence of CAM as important to them were more likely to have self-prescribed herbal medicines (OR=7.15; 95% CI: 1.72, 29.64) than those who did not express an interest in knowledge about evidence of CAM.Conclusion: Certain key attitudes toward CAM influence back pain sufferers' choice of CAM use, highlighting the need for back pain care providers to ensure appropriate enquiry and discussion with their patients regarding consulting CAM practitioners and/or self-prescribing CAM products for back pain. [ABSTRACT FROM AUTHOR]

Background: Complementary and alternative medicine (CAM) use is increasingly popular amongst general populations around the world with women constituting substantial CAM users. However, self-prescribed CAM use does raise potential safety concerns and so it is important to identify those risk factors associated with self-prescribed CAM use.Methods: Data was obtained from the Australian Longitudinal Study on Women's Health (ALSWH). Longitudinal data analyses were conducted on questionnaire data from the 1973-78 cohort (n=9,145) and the 1946-51 cohort (n=10,638), collected over the period 2006-2010.Results: In the 1973-78 cohort, use of self-prescribed CAM was 73.2% in 2006 and 75.3% in 2009. For the 1946-51 cohort, use of self-prescribed CAM was 73.9% in 2007 and 74.7% in 2010. There were similar levels of use of individual self-prescribed CAM, with the exception that the use of herbal medicine was much higher among the 1946-51 cohort (20% vs. 27%). There was a substantial increase over three years in the use of vitamins/minerals in both cohorts (21% and 19%, respectively). In contrast, there was a considerable decline over three years in use of aromatherapy oils in both cohorts (34% and 28%, respectively).Conclusion: Self-prescribed CAM use is popular amongst women in Australia and it is important that conventional practitioners providing women's health care be cognizant of such use amongst their patients. In order to ensure effective practice, there is a need for further research to explore women's decision-making and experiences around self-prescribed CAM use. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between self-prescribed complementary and alternative medicine use and menopause-related symptoms, stratified by menopausal status.Methods: Data were obtained from a cross-sectional survey of a nationally representative sample of 10,011 menopausal women from the Australian Longitudinal Study on Women's Health, conducted in 2010. Multivariable logistic regression models were applied to identify if the use of selected self-prescribed complementary and alternative medicine was significantly associated with a range of menopause-related symptoms.Results: Vitamins/minerals were more likely to be used by natural menopausal women experiencing anxiety (adjusted OR=1.20) and/or stiff/painful joints (adjusted OR=1.16). Yoga/meditation was more likely to be used by women with hysterectomy (adjusted OR=1.76) or natural menopausal women (adjusted OR=1.38) experiencing anxiety. Herbal medicines were more likely to be used by natural menopausal women experiencing anxiety (adjusted OR=1.22), tiredness (adjusted OR=1.20), and/or stiff/painful joints (adjusted OR=1.17), and by women with oophorectomy experiencing tiredness (adjusted OR=1.45). Aromatherapy oils were more likely to be used by natural menopausal women experiencing night sweats (adjusted OR=1.25) and by women with hysterectomy experiencing anxiety (adjusted OR=2.02). Chinese medicines were more likely to be used by women with oophorectomy experiencing stiff/painful joints (adjusted OR=4.06) and/or palpitations (adjusted OR=3.06).Conclusions: Our study will help improve the patient-provider communication regarding complementary and alternative medicine use for menopause, and we conclude that menopausal status should be taken into account by providers for menopause care. The women's experience and motivations of such use warrant further research. [ABSTRACT FROM AUTHOR]

Introduction Research and scholarly activity is considered a key feature which differentiates universities from technical colleges. The development of a research culture in a higher education institution (HEI) which primarily focuses on complementary medicine (CM) education faces unique challenges. However, little is known about the factors influencing research activity as they relate to institutions responsible for CM practitioner education. Methods A cross-sectional online survey of academic and operational staff was conducted at a dual sector private CM education institution in Australia. The survey included items examining respondent attitudes and beliefs about research, personal research experience, and future intended research activity. Statistical analysis determined descriptive frequencies. Backwards stepwise logistic regression was used to identify characteristics of faculty interested in enrolling in a higher degree by research (HDR). Results The survey was completed by 202 of 389 academics. Respondents perceived research as important to their personal professional goals (86.0%) although confidence in being able to undertake research was less common (56.5%). The perceived importance of publication of research to the respondents’ personal professional goals was also notably high (80.0%) although confidence in their own ability to produce research publications was lower (52.9%). A number of key characteristics were identified for those interested in enrolling in a HDR including confidence in certain research methods and experience with publishing research. Discussion/Conclusion The findings from this analysis may prove useful to early career researchers, educational administrators and research leaders in CM organisations transitioning from a teaching institution to a research-focused academic centre of excellence. [ABSTRACT FROM AUTHOR]

Background: Stroke is a common cause of mortality and morbidity which affects approximately 17 million people globally each year. Common symptoms associated with stroke are physical disabilities, impaired cognitive functions, depression, and fatigue, all of which can significantly impact health-related quality of life (HRQoL). To date, no research has explored the inter-relationship among fatigue, disability, depression, health-related hardiness, and quality of life in stroke survivors.Methods: Data was obtained from a sub-study of the 45 and Up Study; including 576 Australian adults who had been diagnosed with a stroke. The cross-sectional questionnaire obtained demographic and health status information, as well as clinical measures and stroke-related measures. Associations among fatigue and disability, depression, health-related hardiness and quality of life were analysed using a linear regression model.Results: In comparison to those participants with no stroke-related disability, those with slight (β = 1.141; p = 0.008), moderate (β = 3.250; p < 0.001) or severe (β = 3.526; p < 0.001) disability had significantly higher fatigue scores. For every one unit increase in the depression score, the fatigue score increased by 1.502 points (p < 0.001). For every one unit increase in the health-related hardiness score, the fatigue score decreased by 0.054 points (p = 0.044). For every one unit increase in the quality of life score, the fatigue score decreased by 0.068 points (p < 0.001).Conclusion: This study found significant associations among fatigue and disability, depression, health-related hardiness, and quality of life in stroke survivors. Accurate detection and management of fatigue may help improve the rehabilitation of stroke survivors. [ABSTRACT FROM AUTHOR]

Background context Back pain is the most prevalent of musculoskeletal conditions, and back pain sufferers have been identified as high users of complementary and alternative medicine (CAM). Despite lacking evidence, CAM treatments (eg, acupuncture, chiropractic, and massage) and CAM products (eg, vitamins, supplements, and aromatherapy oils) for back pain care have become widely available internationally, and CAM use by back pain sufferers has become a significant health service issue. However, to date, there has been no integrative review on CAM use for back pain. Purpose This study aims to conduct an integrative review on CAM use for back pain focusing on prevalence of use, commonly used CAM, characteristics of users, factors influencing decision making, self-perceived effectiveness, and communication with health-care providers. Study design/setting The study is based on an integrative literature review. Methods A comprehensive search of international literature from 2000 to 2014 in MEDLINE, CINHAL, AMED, DARE, EMBASE, ExceptaMedica, psycINFO, and SCOPUS databases was conducted. The search was limited to peer-reviewed articles published in English language and reporting empirical research findings on CAM use for back pain. Results The review reveals a considerable variation in prevalences of CAM use for back pain internationally. Acupuncture, chiropractic, osteopathy, and massage therapy are the commonly used CAM treatments besides a range of self-prescribed CAM, and back pain sufferers use CAM alongside conventional medical treatments. Female gender, chronicity of back pain, and previous exposure to CAM are key predictors of CAM use for back pain as highlighted from the reviewed literature. Family, friends, and recommendation by doctors appear to influence decision making on CAM use for back pain. The review reveals that users of CAM for back pain tend to report CAM as beneficial, but there is little knowledge on communication between CAM users with back pain and health-care providers about such use. Existing literature is largely based on the research investigating CAM use for back pain among a range of other health conditions. Further rigorous research is needed to investigate the use of a wider range of CAM treatments, particularly self-prescribed CAM for back pain. Conclusions The review findings provide insights for health-care providers and policy makers on the range of CAM treatments used by back pain sufferers. Conventional medical and CAM practitioners should be aware of back pain sufferers’ decision making regarding a range of CAM treatments and be prepared to communicate with patients on safe and effective CAM treatments for back pain. [ABSTRACT FROM AUTHOR]

Aim: women use various labour pain management techniques during birth. The objective of this study is to investigate women's use of pharmacological and non-pharmacological labour pain management techniques in relation to birth outcomes. Methods: a sub-survey of a nationally representative sample of pregnant women (n=1835) from the Australian Longitudinal Study on Women's Health. Results: our analysis identified women's use of water for labour pain management as decreasing the likelihood of their baby being admitted to special care nursery (OR=0.42, p<0.004) whereas the use of epidural increased this likelihood (OR=3.38, p<0.001) as well as for instrumental childbirth (OR=7.27, p<0.001). Epidural and pethidine use decreased women's likelihood of continuing breast-feeding (ORs=0.68 and 0.59, respectively, both p<0.01) whereas the use of breathing techniques and massage for pain control increased the likelihood of women continuing breast-feeding (ORs=1.72 and 1.62, respectively, both p<0.01). Conclusions: our study illustrates associations between the use of both pharmacological and nonpharmacological labour pain management techniques and selected birth outcomes while controlling for confounding variables. There remain significant gaps in the evidence base for the use of nonpharmacological labour pain control methods and our findings provide a platform with which to develop a broad clinical research programme around this topic. [ABSTRACT FROM AUTHOR]

Objective: there is evidence of high use of complementary and alternative medicine (CAM) by pregnant women. Despite debate and controversy regarding CAM use in pregnancy there has been little research focus upon the impacts of CAM use on birth outcomes. This paper reports findings outlining the incidence of adverse birth outcomes among women accessing CAM during pregnancy. Design: a survey-based cohort sub-study from the nationally-representative Australian Longitudinal Study on Women's Health (ALSWH) was undertaken in 2010. Participants: women (aged 31-36 years) who identified in 2009 as pregnant or recently given birth (n=2445) from the younger cohort (n=8012) of ALSWH were recruited for the study. Measurements and findings: participants' responses were analysed to examine the relationship between use of CAM and adverse birth outcomes from their most recent pregnancy. Of the respondents (n=1835; 79.2%), there were variations in birth outcomes for the women who used different CAM. Notably, the outcome which was most commonly associated with CAM use was emotional distress. This was found to occur more commonly in women who practised meditation/yoga at home, used flower essences, or consulted with a chiropractor. In contrast, women who consulted with a chiropractor or consumed herbal teas were less likely to report a premature birth, whilst participation in yoga classes was associated with an increased incidence of post partum/intrapartum haemorrhage. Key conclusions: the results emphasise the necessity for further research evaluating the safety and effectiveness of CAM for pregnant women, with a particular focus on birth outcomes. Implications for practice: health professionals providing care need to be aware of the potential birth outcomes associated with CAM use during pregnancy to enable the provision of accurate information to women in their care, and to assist in safely supporting women accessing CAM to assist with pregnancy, labour and birth. [ABSTRACT FROM AUTHOR]

Objectives Fiji has one of the highest rates of rheumatic heart disease in the world. Humanitarian fly-in/fly-out surgical teams, including Open Heart International, have been conducting valve replacement surgery in Fiji since 1991. We sought to determine the short- and long-term outcomes of valve replacement for rheumatic heart disease. Methods The Open Heart International team performed surgery on 167 patients from 1991 to 2011. Complete follow-up data to death or last evaluation on 149 patients (89.2%) and morbidity data for 152 patients (91%) were extracted from medical records. Results Patients' average age at the time of surgery was 26.1 years, with the majority being female (63.5%). Valves replaced were isolated mitral valves (52%), isolated aortic valves (19%), and multiple valves (29%). The cumulative mortality rate at 30, 60, and 90 days and at 1, 5, and 10 years was 2.4%, 6.0%, 8.4%, 12.0%, 19.8%, and 23.9%, respectively. Major adverse valve-related events-free survival was 10.1 years (95% confidence interval [CI], 8.32-11.94). After adjusting for confounders, female patients were 3.03 times more likely to die postoperatively than male patients (odds ratio [OR], 3.03; 95% CI, 1.23-7.69). Patients undergoing isolated valve replacement were less likely to have a morbidity event than those undergoing multiple valve replacement (isolated mitral 67% less likely [OR, 0.33; 95% CI, 0.12-0.93] and isolated aortic 76% less likely [OR, 0.34; 95% CI, 0.06-0.96]). Conclusions The majority of people undergoing valve replacement for rheumatic heart disease have good outcomes. Mortality and morbidity rates at 1 and 5 years, particularly for female patients, are cause for concern and indicate a need for evaluation of resources toward systematic long-term postoperative surveillance and medical management. [ABSTRACT FROM AUTHOR]

Abstract: Background: While some studies have reported effectiveness of aromatherapy oils use during labour there is no reported evidence of efficacy or risks of aromatherapy oils use for pregnancy-related symptoms or conditions. A number of aromatherapy oils are unsafe for use by pregnant women yet there is currently no research examining the prevalence and characteristics of women who use aromatherapy oils during pregnancy. Aim: To conduct an empirical study of the prevalence and characteristics of women who use aromatherapy oils during pregnancy. Methods: The research was conducted as part of the Australian Longitudinal Study on Women's Health (ALSWH), focusing on the nationally representative sample of Australian women aged 31–36 years. Data were collected via a cross-sectional questionnaire (n =8200) conducted in 2009. Results: Self-prescribed aromatherapy oils were used by 15.2% of pregnant women. Pregnant women were 1.57 (95% CI: 1.01, 2.43) times more likely to self-prescribe use of aromatherapy oils if they have allergies or hayfever, and 2.26 (95% CI: 1.34, 3.79) times more likely to self-prescribe use of aromatherapy oils if they have a urinary tract infection (UTI). Conclusion: Our study highlights a considerable use of aromatherapy oils by pregnant women. There is a clear need for greater communication between practitioners and patients regarding the use of aromatherapy oils during pregnancy, as well a need for health care practitioners to be mindful that pregnant women in their care may be using aromatherapy oils, some of which may be unsafe. [Copyright &y& Elsevier]

OBJECTIVE: To examine the prevalence and characteristics of women who self-prescribe complementary and alternative medicine (CAM) for back pain. METHODS: A cross-sectional survey of a nationally-representative sample of women aged 60-65 years from the Australian Longitudinal Study on Women's Health (ALSWH). RESULTS: A significant number of women (75.2%, n=985) self-prescribed one or more CAM for back pain in the previous twelve months. Use of self-prescribed CAM for back pain was not associated with socio-economic status. The most common self-prescribed CAM used by women was supplements (n=776, 59.2%), vitamins/minerals (n=592, 45.2%), yoga/meditation (n=187, 14.3%), herbal medicines (n=172, 13.1%) and aromatherapy oils (n=112, 8.6%). Women who visited general practitioners (GPs) more than three times in the previous twelve months were 1.59 times (95% CI: 1.14, 2.22) more likely to self-prescribe CAM for back pain than those women who did not visit GPs. Women who visited a pharmacist three or more times in the previous twelve months were 2.90 times (95% CI: 1.65, 5.09) more likely to self-prescribe CAM for back pain than those women who did not visit a pharmacist. CONCLUSION: This study identifies substantial use of self-prescribed CAM by women for back pain regardless of their education, income or urban/rural residency. In order to ensure safe, effective practice it is important that all providing and managing health services for back pain sufferers remain mindful of patients' possible use of self-prescribed CAM. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is no Australian data on the characteristics of women who consult with midwives. Aim: To determine the profile of women who consult midwives in Australia. Methods: This cross-sectional research was conducted as part of the Australian Longitudinal Study on Women's Health (ALSWH). Participants were the younger (31–36 years) cohort of the ALSWH who completed a survey in 2009, and indicated that they were currently pregnant (n =801). The main outcome measure was consultation with a midwife. Findings: Of the 801 women who indicated that they were currently pregnant at the time of the survey, 19%, 42%, and 70% of women in the first, second and third trimesters respectively had consulted with a midwife. Women were more likely to consult a midwife if they: also consulted with a hospital doctor (OR=2.70, 95% CI: 1.66, 4.40); also consulted with a complementary and alternative medicine practitioner (OR=1.94, 95% CI: 1.25, 3.03); were depressed (OR=1.84, 95% CI: 1.03, 3.28); constipated (OR=1.80, 95% CI: 1.04, 3.13); or had been diagnosed or treated for hypertension during pregnancy (OR=2.78, 95% CI: 1.27, 6.09). Women were less likely (OR=0.34, 95% CI: 0.21, 0.56) to consult with a midwife if they had private health insurance. Conclusion: Women were more likely to consult with midwives in conjunction with consultations with hospital doctors or complementary and alternative medicine practitioners. Women with private health insurance were less likely to consult midwives. More research is necessary to determine the implications of the lack of midwifery care for these women. [Copyright &y& Elsevier]

Abstract: Objectives: Massage therapists are an important part of the health care setting in rural and regional Australia and are the largest complementary and alternative medicine (CAM) profession based on both practitioner numbers and use. The purpose of this study was to survey medical general practitioners (GPs) in rural and regional New South Wales, Australia, to identify their knowledge, attitudes, relationships, and patterns of referral to massage therapy in primary health care. Methods: A 27-item questionnaire was sent to all 1486 GPs currently practicing in rural and regional Divisions of General Practice in New South Wales, Australia. The survey had 5 general areas: the GP's personal use and knowledge of massage, the GP's professional relationships with massage practice and massage practitioners, the GP's specific opinions on massage, the GP's information-seeking behavior in relation to massage, and the GP's assumptions on massage use by patients in their local areas. Results: A total of 585 questionnaires were returned completed, with 49 survey questionnaires returned as “no longer at this address” (response rate of 40.7%). More than three-quarters of GPs (76.6%) referred to massage therapy at least a few times per year, with 12.5% of GPs referring at least once per week. The GP being in a nonremote location (odds ratio [OR], 14.28; 95% confidence interval [CI], 3.7-50.0), graduating from an Australian medical school (OR, 2.03; 95% CI, 1.09-3.70), perceiving a lack of other treatment options (OR, 2.64; 95% CI, 1.15-6.01), perceiving good patient access to a wide variety of medical specialists (OR, 11.1; 95% CI, 1.7-50.0), believing in the efficacy of massage therapy (OR, 2.75; 95% CI, 1.58-4.78), experiencing positive results from patients using massage therapy previously (OR, 13.95; 95% CI, 5.96-32.64), or having prescribed any CAM previously (OR, 1.83; 95% CI, 1.03-3.27) were all independently predictive of increased referral to massage therapy among the GPs in this study. Conclusions: There appears to be substantial interface between massage therapy and GPs in rural and regional Australia. There are high levels of support for massage therapies among Australian GPs, relative to other CAM professions, with low levels of opposition to the incorporation of these therapies in patient care. [Copyright &y& Elsevier]

Abstract: Aim of the study: To analyse the use of complementary and alternative medicine (CAM), allied health and biomedicine for back pain amongst Australian women aged 60–65. Methodology: Self-completion postal survey in 2011/2012 of 1310 women who reported seeking help for back pain from the mid-age cohort of the Australian Longitudinal Study on Women''s Health (ALSWH). Questions asked about their use of, and attitudes towards, CAM, allied health and biomedicine for the treatment of back pain. Results: Intensity of back pain was greater for those who consulted biomedical and allied health practitioners. Women reported seeking help from biomedical and allied health practitioners more quickly after onset of pain than CAM practitioners but the longer their pain persisted the more likely they were to consult CAM practitioners. Use of CAM reflected less perceived benefit of biomedicine and allied health. The perceived differences in approach of CAM practitioners (e.g. more time in consultation, more equal relationship, more holistic approach) may be influential in their use and perceived benefit. Ease of access/availability may also influence use of CAM in particular. Some communication limitations were reported regarding discussing the use of other practitioner groups with biomedical and CAM practitioners. Conclusions: Help for back pain occurs within highly differentiated contexts of care with patients juggling multiple and often ideologically distinct provider groups in order to improve their health and well-being. Further detailed research is required to examine patient motivations and pathways across biomedical, allied health and CAM providers in order to facilitate continuity of clinical care. [Copyright &y& Elsevier]