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The present study was conducted in a cross-sectional and descriptive design to examine the attitudes of hypertension patients toward using complementary treatments. The study was conducted with 173 patients who had the diagnosis of hypertension who applied to the Cardiology Clinics of a University Health Practice and Research Hospital between 15.12.2021 and 10.03.2022. Before starting the study, permission was obtained from the ethics committee, institution, and patients. The data of the study were collected through face-to-face interviews, a questionnaire, and the Attitude Scale Toward Using Complementary Treatments (ASUCT). The score to be obtained from the scale varies between 0 and 39 and a high score indicates a positive attitude toward complementary treatments. One-Sample Kolmogorov-Smirnov test was used to evaluate the homogeneity of the data. The Student t, Mann-Whitney U test, correlation, and ANOVA tests were also used to evaluate the data, and P < .05 was considered statistically significant. It was found that 55.0% of the patients were women, 31.2% were between the ages of 44 to 56, 63.0% had other chronic diseases, and 68.2% preferred herbal applications in the management of hypertension. It was also found that the mean ASUCT score of hypertensive individuals was 21.13 ± 2.99, and there was a statistically significant relationship between the mean ASUCT score of the patients and their gender, education level, and reasons for applying to herbal therapy (P < .05). Patients frequently preferred the consumption of pomegranate syrup (43.4%), garlic (36.4%), and quince leaf tea (30.8%) as non-drug applications in the management of hypertension. It was found that the attitudes of the hypertension patients toward using complementary treatments were at a "moderate" level and there was a relationship between their level of attitude toward using complementary treatments and gender, education, and the reasons for applying herbal therapy. In this respect, it is recommended to evaluate the attitudes of hypertension patients toward using complementary treatments, to learn the practices they prefer for disease management through patient-health care professional interaction, and to support patients for hypertension management., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: While many patients with neurological disorders and conditions use complementary, alternative, and integrative medicine (CAIM), little is known about the use, perceptions, and attitudes regarding CAIM among published neurology authors. With the increasing popularity of CAIM, our objective was to assess practices, perceptions, and attitudes towards CAIM among published neurology authors., Methods: We conducted an anonymous online survey of authors who had published articles in neurology journals indexed in MEDLINE. We emailed potential participants our cross-sectional electronic survey after extracting their email addresses from one of their publications in our sample of journals. Basic descriptive statistics were drawn from quantitative data, and thematic content analysis was used to analyse qualitative data from any open-ended questions., Results: The survey was completed by 783 published neurology authors (1.7% response rate, 83.9% completion rate). Overall, respondents perceived CAIM to be promising in preventing, treating, and/or managing neurological diseases. Mind-body therapies received the most positive responses, indicated by over half of respondents cumulatively agreeing that they are promising (n = 368, 59.0%) and safe (n = 280, 50.3%). Whole medical systems and biofield therapy were less favourable. Most neurology clinicians reported a lack of formal (n = 211, 70.3%) and supplementary training (n = 158, 52.5%) on CAIM. Nearly half of clinicians did not feel comfortable counselling patients about CAIM therapies (n = 121, 44.5%), and over half did not feel comfortable recommending them (n = 161, 59.3%). A lack of scientific evidence for CAIM's safety and efficacy was reported as the greatest challenge to CAIM (n = 515, 92.5%). The majority of respondents believed there is value to conducting research on this topic (n = 461, 82.0%) and supported increasing allocation of research funding towards CAIM (n = 241, 58.9%)., Conclusions: Although many participants found CAIM to be promising to the field of neurology, the vast majority did not feel open to integrating CAIM into mainstream medical practices on account of a perceived lack of scientific evidence for its safety and efficacy. Future studies can use our findings to gather more detailed insights, improve educational resources on CAIM within neurology, as well as examine what effects a tailored CAIM education has on the perceptions and attitudes of published neurology authors towards CAIM., (© 2024. The Author(s).)

Background: Cancer patients have high supportive care needs related to the nature of the disease and treatment methods. To meet these needs or reduce symptoms, patients can be expected to resort to alternative treatment methods., Aim: To examine the relationship between the supportive care needs of cancer patients and their attitudes toward complementary and alternative medicine (CAM)., Methods: This was a cross-sectional study involving 289 cancer patients at the Oncology Hospital in east of Turkey. Short-Form Supportive Care Needs Survey Questionnaire (SCNS-SF 29) and Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ) were standard instruments used for data collection. The association between supportive care needs and attitude toward CAM was determined., Results: The mean age of the study participants was 56.7 ± 12.7 years. There were 180 females (62.3%) and 109 males (37.7%). The mean score of the SCNS-SF 29 of the study participant was 101.19 ± 33.97. It was found that the patients' psychological needs were the highest, followed by health services and information, daily life, and sexuality needs, respectively. The mean score of the HCAMQ was 27.16 ± 9.54. There was a weak, significant negative correlation between HCAM and psychological supportive care needs (r: -0.240, P: 0.003). However, there was no significant relationship between needs related to health services information, daily life sexuality, and attitudes toward CAM., Conclusions: Cancer patients have high supportive care requirements. Those with high psychological needs have a positive attitude toward HCAM. Incorporation of HCAM in the care of cancer patients may improve their quality of care., (Copyright © 2024 Copyright: © 2024 Nigerian Journal of Clinical Practice.)

Background: Cancer often causes reduced resilience, quality of life (QoL) and poorer overall well-being. To mitigate these problems, complementary and alternative medicine (CAM) is widely used among patients with cancer. This study aimed to evaluate the long-term effects of an interdisciplinary integrative oncology group-based program (IO-GP) on the resilience and use of CAM in patients with cancer., Methods: This was a prospective, observational, single-center study. Resilience (RS-13), CAM usage (I-CAM-G), QoL (SF-12) and health-related lifestyle factor (nutrition, smoking, alcohol consumption and physical exercise) data were collected for 70 patients who participated in a 10-week IO-GP between January 2019 and June 2022 due to cancer. The IO-GP is offered at the setting of a university hospital and is open to adult patients with cancer. It contains elements from mind-body medicine and positive psychology, as well as recommendations on healthy diet, exercise and CAM approaches. Patients who completed the IO-GP at least 12 months prior (1-4.5 years ago) were included in this study. Statistical analysis included descriptive analysis and parametric and nonparametric tests to identify significant differences ( P  < .05)., Results: Resilience increased significantly ≥12 months after participation in the IO-GP (n = 44, P  = .006, F  = 8.274) and had a medium effect size ( r  = .410). The time since the IO-GP was completed ("12-24 months," "24-36 months," and ">36 months") showed no statistically significant interaction with changes in resilience ( P  = .226, F  = 1.544). The most frequently used CAM modalities within the past 12 months were vitamins/minerals (85.7%), relaxation techniques (54.3%), herbs and plant medicine (41.1%), yoga (41.4%) and meditation (41.4%). The IO-GP was the most common source informing study participants about relaxation techniques (n = 24, 64.9%), meditation (n = 21, 72.4%) and taking vitamin D (n = 16, 40.0%). Significantly greater levels of resilience were found in those practicing meditation ( P  = .010, d  = -.642) or visualization ( P  = .003, d  = -.805) compared to non-practitioners., Conclusion: IO-GPs have the potential to empower patients with cancer to continue using CAM practices-especially from mind-body medicine-even 1 to 4.5 years after completing the program. Additionally, resilience levels increased. These findings provide notable insight into the long-term effects of integrative oncology interventions on resilience and the use of CAM, especially in patients with breast cancer., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Generally, patients with chronic rheumatic diseases use complementary and alternative medicine (CAM) in addition to their conventional treatments to manage their health. Discussing these treatments with their physician is still rare, which might be directly related to patients' trust toward them., Aim: The primary objective of this study was to assess the association between patients' trust in their physician and the use of complementary and alternative medicine among patients with chronic inflammatory rheumatic diseases. As secondary objectives, to estimate the prevalence of CAM use, and to identify the associated factors with their use and with trust in physicians., Methods: This is a cross-sectional study, which included patients with established chronic inflammatory rheumatic diseases, at the University Hospital Center in Tangier. The questionnaire included demographic and clinical information, use of conventional therapy, complementary and alternative therapy, as well as interpersonal trust in patient-physician relationships using the Trust in Physician Scale (TPS). A regression analysis was conducted to identify factors associated with CAM use and with trust in physicians., Results: The study included 189 patients. 57.14% of patients reported using complementary medicine at least once, most patients were women (77.78%), mean age was 46.67 ± 13.25 years with an average course of the disease of 11.11 ± 9.23 years. The most frequently used CAM treatments were cupping therapy, massage and the ingestion of a mixture of plants. Mean ± SD Trust in Physician Scale was 47.64 ± 7.2. There was no significant difference between CAM users vs. non-users (48.08 ± 6.9 vs 47.04 ± 7.4; p = 0.35). In uni and multivariate analysis, a low level of education was significantly associated with the use of CAM. However, no statistically significant difference was found with trust in physicians (OR = 1.020, 95% CI (0.978-1.063), p = 0.354)., Conclusion: CAM therapy is common in patients with chronic inflammatory rheumatic diseases. No statistically significant association was found with trust in physicians, it was rather observed with level of education., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Lay Abstract: Latino parents may choose to use complementary health approaches, such as vitamins, supplements, and special diets, for their autistic children. However, they might not tell their pediatrician about their complementary health approach use if they worry that the pediatrician will disapprove or judge them. This fear, along with pediatricians' lack of autism knowledge, creates barriers to "shared decision-making" between parents and pediatricians. Shared decision-making is a process where families and healthcare providers collaborate and exchange information in order to come to an agreement about treatment options. In our qualitative study with 12 bilingual Latino families of autistic children, we interviewed and observed families to learn about their experiences with both conventional healthcare (their pediatrician) and complementary health approaches. Our study results describe the parents' different pathways to an autism assessment, a process that is sometimes called the "diagnostic odyssey." The parents reported that conventional healthcare met their needs for their child's physical health but not for their child's developmental challenges. The parents who used complementary health approaches for their autistic children were more frustrated about a lack of autism information from pediatricians than those who did not use complementary health approaches. Finally, we describe two examples of successful shared decision-making between parents and pediatricians. We conclude that pediatricians who are able to talk about complementary health approaches with Latino families may help to facilitate shared decision-making and reduce healthcare disparities for Latino autistic children., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Poland has a unique history of traditional Chinese medicine (TCM) dating back to the 17th century when Polish missionary Michael (Michał) Boym was a pioneer in the field. In the 20th century, his successor, Professor Zbigniew Garnuszewski, reintroduced acupuncture to medical practice in Poland. However, other methods of TCM and its holistic approach to patient care have not found their place in modern medicine in Poland. At present, the legal status of TCM in Poland remains unregulated, with TCM included in the broad spectrum of complementary and alternative medicine (CAM) practices. Few reports are available on the use of TCM methods among the Polish population. Integrative medicine combines conventional medicine with evidence-based CAM interventions and considers all aspects of a patient's health, including physical, emotional, mental, social, and environmental factors. An integrative healthcare model that incorporates TCM modalities and lifestyle recommendations as well as a whole person approach may provide a more sustainable solution for the constantly underfinanced Polish healthcare system, which faces challenges of multimorbidity in an aging society and limited access to care. The coronavirus disease 2019 pandemic, war in Ukraine, and ongoing climate crisis have underscored the need to strengthen the resilience of the Polish healthcare system and search for new solutions. A model of care that blends the best of biomedicine and TCM healing approaches may be a better option for both patients and the healthcare system in Poland. Please cite this article as: Rybicka M, Zhao J, Piotrowicz K, Ptasnik S, Mitka K, Kocot-Kępska M, Hui KK. Promoting whole person health: Exploring the role of traditional Chinese medicine in Polish healthcare. J Integr Med. 2023; 21(6): 509-517., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Shanghai Changhai Hospital. Published by Elsevier B.V. All rights reserved.)

Objective: The aim of this cohort study was to gain insight on influencing factors on the decision-making process in conventional medicine compared to complementary and alternative medicine (CAM)., Methods: A standardized questionnaire was distributed among cancer patients who attended the counselling facility for CAM of a German university hospital in 2020., Results: Fifty patients (30.3%) returned the questionnaire. After counselling on CAM, most patients made a decision in CAM but also in conventional medicine. Thus, the focus on informed decision-making during counselling on CAM had a strong effect on the decision-making process in conventional medicine. Patients reporting good support also reported making decisions together with physicians and relatives. Moreover, after counselling on CAM, patients reported being more satisfied with their decision in both settings afterwards., Conclusion: Information on CAM which focuses on informed decision-making, supports patient's ability to understand and weigh risks and benefits of treatments, supports shared decision-making and enables patients to transfer these competences also to decisions on conventional medicine. So counselling on CAM may further decision-making competences in cancer patients. This encourages patients to engage in shared decision-making and increases patient's satisfaction with decisions., (© 2022. The Author(s).)

Objective: Patients with gynecological cancer commonly use complementary and alternative medicine (CAM) methods to cope with the disease. However, despite the existence of treatment strategies, the effect of fear and anxiety caused by coronavirus disease 2019 (COVID-19) pandemic on attitudes about CAM use is unclear. This study was carried out to investigate the effect of fear and anxiety experienced by patients with gynecological cancer during the COVID-19 pandemic on their attitudes towards the use of CAM., Methods: This is a cross-sectional and descriptive study that included 177 women with gynecological cancer; participants were recruited from a social networking site for cancer patients in Turkey between June and December 2021. Data were collected using an online survey that included the Personal Information Form, the Fear of COVID-19 Scale, the Coronavirus Anxiety Scale, and the Attitude Towards Holistic Complementary and Alternative Medicine Scale. Descriptive statistics, t-test, Pearson's correlation test, and simple linear and multiple regression analyses were performed to analyze the data., Results: During the pandemic, 55.4% of the participants reported using CAM methods, but only 22.6% were using CAM before the pandemic. The participants who used CAM during the pandemic also scored higher on the fear of COVID-19 and coronavirus anxiety scales (20.69 ± 5.37 and 13.09 ± 6.29, respectively) compared to the participants who did not use CAM (9.29 ± 2.72 and 6.35 ± 2.06, respectively). Fear of COVID-19 accounted for 52% of the CAM attitude score, while coronavirus anxiety accounted for 15% of the CAM attitude score. Fear of COVID-19 and coronavirus anxiety together accounted for 53% of CAM attitude., Conclusion: Gynecological cancer patients with high levels of COVID-19-related anxiety and fear during the pandemic used CAM more. Given that the psychological effects of the pandemic will continue in the coming years, CAM use should be evaluated as a coping strategy, especially due to the COVID-19-related anxiety and fear experienced by patients with gynecological cancer. While the rational and effective CAM methods should be supported, strategies should be developed to prevent misuse of CAM and its interference in prescribed medical treatments. Please cite this article as: Uslu-Sahan F, Yesilcınar I, Kurt G, Hancer E, Guvenc G. Effects of COVID-19 fear and anxiety on attitudes towards complementary and alternative medicine use in women with gynecological cancer during the COVID-19 pandemic. J Integr Med. 2023; 21(4): 377-384., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Shanghai Changhai Hospital. Published by Elsevier B.V. All rights reserved.)

Purpose: Studies have shown that patients with cancer are more likely to use complementary and alternative medicine (CAM) than noncancer patients for symptom relief and hope. We aimed to evaluate factors of race, ethnic groups, and immigration status in attitude of patients with cancer in seeking out CAM., Patients and Methods: This is a prospective questionnaire study where information on demographics, cancer information, race/ethnicity, immigration duration, and psychosocial factors was correlated with the CAM use in a community cancer center located in the borough of Brooklyn, at New York City., Results: Among 658 patients, the prevalence of CAM use was 66.11%. CAM use was 71.98% in females and 54.34% in males ( P = .113 × 10 -4 ). Patients of African descent had higher CAM use (72.73%) than the White patients (63.53%; P = .0371). There was no difference of CAM use between the US born (68.77%) and the immigrants (63.98%, P = .199) as a whole; however, comparing with the US born (66.50%), Asian-born immigrants had lower CAM use (53.77%, P = .0161), whereas Latin-American born had a numerical trend toward higher CAM use (74.83%, P = .0608). The number of years of living in the United States was not associated with more CAM use. Prayer and spirituality was the most common CAM subtype used (25.91%). There was no difference in CAM use in the respective non-White ethnic groups whether they were US born or non-US born., Conclusion: In this cohort of patients with cancer enriched with immigration background, CAM use was the highest in African American patients. The use of CAM in the non-White patients was associated with their ethnic background, regardless whether they were US born or not. Cultural roots appeared to be a strong influencing factor for the usage of CAM.

Complementary and alternative medicine (CAM) use in children with cancer has a high prevalence. If (parents of) patients bring up the topic of CAM, pediatric oncologists (POs) face considerable challenges regarding knowledge and professional behavior. In this study, we explore German POs' understanding of CAM and related attitudes as well as challenges and strategies related to CAM discussions by means of semi-structured interviews analyzed according to principles of qualitative thematic analysis with parents of children with cancer. We could conduct 14 interviews prior to theoretical saturation. The interviews had a duration of 15-82 min ( M  = 30.8, SD  = 18.2). Professional experience in pediatric oncology was between 0.5 and 26 years ( M  = 13.8, SD  = 7.6). Main themes identified were a heterogeneous understanding and evaluation of CAM, partly influenced by personal experiences and individual views on plausibility; the perception that CAM discussions are a possible tool for supporting parents and their children and acknowledgement of limitations regarding implementation of CAM discussions; and uncertainty and different views regarding professional duties and tasks when being confronted with CAM as a PO. Our interdisciplinary interpretation of findings with experts from (pediatric) oncology, psychology, and ethics suggests that there is need for development of a consensus on the minimal professional standards regarding addressing CAM in pediatric oncology.

Many people believe in and use complementary and alternative medicine (CAM) to address health issues or prevent diseases. Empirical evidence for those treatments is either lacking or controversial due to methodological weaknesses. Thus, practitioners and patients primarily rely on subjective references rather than credible empirical evidence from systematic research. This study investigated whether cognitive and personality factors explain differences in belief in CAM and homeopathy. We investigated the robustness of 21 predictors when examined together to obtain insights into key determinants of such beliefs in a sample of 599 participants (60% female, 18-81 years). A combination of predictors explained 20% of the variance in CAM belief (predictors: ontological confusions, spiritual epistemology, agreeableness, death anxiety, gender) and approximately 21% of the variance in belief in homeopathy (predictors: ontological confusions, illusory pattern perception, need for cognitive closure, need for cognition, honesty-humility, death anxiety, gender, age). Individuals believing in CAM and homeopathy have cognitive biases and certain individual differences which make them perceive the world differently. Findings are discussed in the context of previous literature and in relation to other unfounded beliefs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Aßmann, Betsch. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This evaluation explored the benefits of Complementary Alternative Medicine (CAM) within a reservation-based, State-certified outpatient treatment provider. The three CAM strategies provided were massage, acupuncture, and chiropractic therapies. The evaluation team worked with a peer recovery support specialist and tribal evaluation intern to co-create a one-page, eight-question, fixed-response instrument based on previous work in the community. Surveys were collected by the peer support specialist post-session with individuals receiving CAM therapies. Surveys assessed self-reported impacts, reasons for attending CAM sessions, and mental, physical, spiritual, and emotional health before and after CAM sessions. Paired t-tests were used to examine significant differences in mean scores before and after CAM sessions. A total of 40 participants completed the survey between March 2021 and March 2022. The evaluation found a significant increase in the mean scores for all measured self-reported health ratings: physical, spiritual, emotional, and mental. The greatest increase observed was for physical health (M = 5.32, SD = 2.53) and physical health after (M = 8.38, SD = 1.60) based on self-report data; t(78) = 6.46, p = .0001. CAM sessions positively influenced participants; 83% (n = 33) reported being more hopeful about their overall health and wellness. The holistic approach demonstrated promising results and potential benefits of CAM on overall wellness and belonging. Further research is needed to explore how CAM may be implemented as a culturally centered approach to managing chronic pain often associated with opioid use disorder.

The aim of this study is to assess the knowledge, attitudes, and practices of complementary and alternative medicine (CAM) among physicians and nurses at the American University of Beirut Medical Center (AUBMC) in Beirut, Lebanon. A web-based survey was emailed to 518 physicians and 423 registered nurses in all medical departments at AUBMC. Of the 94 physicians responding to the survey, 61% have never referred a patient to a CAM practitioner yet 33% reported that they would refer if available. Sixty-two percent of physicians believed that incorporating evidence-based CAM therapies will increase patient satisfaction and 66% thought that offering CAM would attract more patients. Of the 80 nurses who responded, 78.7% have never referred a patient to a CAM practitioner, yet half reported that they would likely refer if a CAM practitioner was available. Fifty-seven percent of nurses surveyed believed that offering CAM would attract more patients while 59% thought that it would increase patient satisfaction. Most nurses were uncomfortable counseling patients about CAM modalities. Favorable attitudes towards CAM were reflected by the physicians and nurses as signified by the above-average attitude means towards CAM (M = 4.01, SD = .16 and M = 3.25, SD = .59, respectively). The study findings demonstrate that despite the physicians' and nurses' limited knowledge and their discomfort in counseling on CAM, they expressed acceptability and willingness in using and incorporating CAM therapies into clinical practice at AUBMC. This is the first study conducted in Lebanon that assesses both nurses' and physicians' perspectives on the use of all CAM domains in general within the same healthcare setting. This study not only provides baseline data but also highlights the knowledge gap and learning needs among physicians and nurses with regards to CAM.

Background: Postmenopausal women are interested in using complementary and alternative medicine because of their menopausal symptoms and the side effects of chemical medications and hormone therapy. Therefore, this study aimed to investigate the relationship between the use of complementary medicine (CAM) and menopausal symptoms among postmenopausal women., Methods: This cross-sectional study was conducted among 288 postmenopausal women who were referred to health centers in Kerman, southeastern Iran, from 2020 to 2021. Data were collected using a demographic questionnaire, the CAM questionnaire, and the Menopause Rating Scale (MRS)., Results: The mean score for the menopausal symptoms of the participants was 8.73 ± 6.11. Only 28.8% of the participants had no/little symptoms. About 65.3% of the participants used at least one type of CAM in the previous year. The most commonly used types of CAM were nutritional supplements, prayer, and medicinal herbs. A significant association was found between the use of medicinal herbs, dry cupping, relaxation and meditation, prayer, and menopausal symptoms. Women experiencing menopausal symptoms used more CAM methods than those without menopausal symptoms (Odds ratio = 2.25, 95% confidence interval = 1.33-3.80)., Conclusion: The study results indicated that the severity of menopausal symptoms and scores in somatic-vegetative and urogenital domains were higher in CAM users compared to non-CAM users. But there was no significant difference in the psychological domain between CAM and non-CAM users. Based on the results, it is suggested that more research be done in different communities with different healthcare systems to find out how complementary and alternative medicine affects menopausal symptoms in women., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Dehghan, Isari, Abbaszadeh and Ghonchehpour.)

Complementary and alternative medicine (CAM) is used as a complementary intervention in psychiatric healthcare. The reasons for using or not using CAM in psychiatric care in Sweden, and how such decisions are taken, are largely unknown. The aim was to investigate arguments for and against the use of CAM in Swedish psychiatric care, and how decisions are made. Interviews with 10 persons in decision-making positions in psychiatric health care were analysed thematically. The result shows diverging understandings of the evidence base for CAM. Arguments against CAM referred to scepticism, the importance of evidence-based practice and the obligation to follow national guidelines. Arguments in favour of CAM were that CAM was person-centred, safe, cost-effective, nursing interventions with positive effects, appreciated and demanded by patients, providing space for non-verbal communication and reflection, supporting the therapeutic alliance. Decision paths were described as top-down through a hierarchical structure, or bottom-up, driven by committed staff members. We discuss how detailed national guidelines should be to achieve equal and evidence-based care, while still allowing clinics to make local exceptions, adjusting the care according to clinical expertise and patients' preferences. Conclusion: Evidence-based, safe and cost-effective CAM methods may be relevant complementary interventions in psychiatric care, or as self-care, not to cure the psychiatric disease, but to reduce symptoms and promote sleep. With better knowledge of CAM, health professionals could guide patients through the jungle of CAM methods. Due to research problems on complex multicomponent interventions, high-quality pragmatic trials, including biomarkers, and qualitative studies are recommended.

Objectives: The use of conventional treatment for work-related musculoskeletal disorders (WRMSDs) reduces the prevalence of pain, but with popularity of complementary alternative medicine (CAM) therapies for treatment, it is important to explore their use and impact on dental hygienists (DHs) quality of life (QoL)., Methods: A cross-sectional survey research design was used with a non-probability sample of dental hygienists (n = 85) with WRMSDs who used CAM therapies. The WHOQOL-BREF was used to assess quality of life and compared with CAM use and frequency. Analysis included descriptive, t-tests, correlation and chi-square tests of independence., Results: The most commonly used CAM types were massage (81%) and chiropractic manipulation (67%) with 66% of respondents using two or more CAM therapies. Participants using five or less different CAMs (n = 46), compared with those using more than five CAM types (n = 35, M = 2.3, SD = 1.5), t (79) = 2.7, p = 0.01, had a higher average number of years before they noticed their WRMSD (M = 3.3, SD = 1.9). Participants reporting use of a higher number of CAM types also had lower QoL physical health domain scores (rho = -0.2, p = 0.03)., Conclusions: Dental hygienists used a variety of CAM approaches to manage WRMSDs and had a lower QoL across all domains (physical health, psychological health, social relationships and environment) than the normative mean. More research is needed to explore the use of CAM approaches, such as yoga, for prevention and management of WRMSDs to improve QoL., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Most studies examining complementary and alternative medicine (CAM) stakeholder engagement with evidence-based practice have relied on quantitative research methods, which often fail to capture the nuances of this phenomena. Using qualitative methods, this study aimed to explore the experiences of CAM stakeholders regarding the barriers and enablers to the conduct and application of research., Methods: This research was guided by a qualitative descriptive framework. CAM practitioners and researchers of multiple CAM disciplines from across Australia and New Zealand were invited to share their personal perspectives of the study phenomena. Semi-structured interviews were conducted via Zoom, which were audio-recorded and transcribed verbatim. Rigour strategies were applied to ensure the credibility of results. The transcript was analysed using thematic analysis., Results: CAM stakeholders identified an array of barriers and enablers to the conduct and application of research within their disciplines. The barriers and enablers that emerged were found to be inter-connected with two similar constructs: capacity and culture. Captured within the construct of capacity were five themes-lack of resources, inadequate governance/leadership, lack of competency, bias directed from outside and within CAM, and lack of time for research. Within the construct of culture were two themes-intrinsic perceptions in CAM, and lack of communication within and outside CAM., Conclusions: Promoting evidence-based practice and engaging with research in CAM continues to face challenges. This study, for the first time, has highlighted the multitude of interlinked barriers that confront CAM stakeholders when engaging with research. These findings highlight the need for a concerted and targeted approach to tackle these challenges., Competing Interests: The authors have declared that no competing interests exist.

Background: The use of Complementary Alternative Medicine (CAM) Methods is increasing and therefore gaining importance also in conventional western medicine. Identifying personal traits to make out by whom and why CAM is used can help physicians in successful physician-patient interaction, and thus improve patient's compliance and trust towards their physician., Patients and Methods: A questionnaire was passed on to cancer patients in an ambulant clinical and a rehabilitation setting. Multiple regression analyses were run to examine possible predictors for CAM use, such as gender, age, level of education, spirituality, attentiveness, self-efficacy and resilience. To differentiate within CAM users, two dependent variables were created: "holistic and mind-body methods", such as Yoga, meditation or Homeopathy and "material based methods", such as food supplements or vitamins., Results: Higher level of education, younger age and religion-independent attentiveness were significant predictors for the use of "material based methods". Female gender, higher education and religious spirituality were detected as significant predictors for "holistic and mind-body methods"., Conclusion: This study is among the first to take a more detailed look at how numerous personal traits are associated with the use of CAM methods and differentiate between the applied methods. Our finding should be considered by conventional health care providers and could be integrated into a holistic assessment, to offer information about complementary medicine and meeting patients' needs., (© 2021. The Author(s).)

Background: This study aimed to investigate the prevalence of and the factors associated with the regular use of complementary therapies for Taiwanese patients with systemic lupus erythematosus (SLE)., Methods: In this cross-sectional study, 351 patients with SLE were consecutively recruited from a regional hospital in southern Taiwan from April to August 2019. Demographic and clinical information, including the use of different types of complementary therapies, was ascertained using a self-constructed questionnaire. Disease-specific quality of life was measured using the Lupus Quality of Life (LupusQoL) questionnaire. SLE disease activity was assessed using the rheumatologist-scored Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K). Factors associated with the regular use of complementary therapies were evaluated using multiple logistic regression analyses., Results: Of the 351 patients with SLE, 90.3% were female, and 60.1% were ≥ 40 years of age. The prevalence of the regular use of any type of complementary therapy was 85.5%. The five most popular types of complementary therapy used were (1) fitness walking or strolling, (2) Buddhist prayer or attending temple, (3) vitamin consumption, (4) calcium supplementation, and (5) fish oil supplementation. Multiple logistic regression analyses revealed that the significant and independent factors associated with the regular use of complementary therapies in patients with SLE were age ≥ 40 years (adjusted odds ratio [aOR] 2.76, p = 0.013), nonoverweight or nonobesity (aOR 0.29, p = 0.004), engagement in vigorous exercise in the past year (aOR 4.62, p = 0.002), a lower SLEDAI-2 K score (aOR 0.90, p = 0.029), and a lower score in the physical health domain of the LupusQoL (aOR 0.57, p = 0.001)., Conclusions: A high prevalence of complementary therapy use in Taiwanese patients with SLE was observed. Rheumatologists should routinely ask patients about their use of supplements to minimize the risk of interaction with medical therapy., (© 2021. The Author(s).)

Background: The present study aims to investigate the knowledge, attitude, and performance of Iranian Healthcare Professionals (HP) about Complementary and Alternative Medicine (CAM) modalities., Methods: This cross-sectional study was carried out on 210 HP in 2019. Samples were selected from healthcare centers, clinics, and hospitals using census sampling. Data collection tools included demographic information, attitude, knowledge, and the amount of use of CAM modalities. Data analysis was performed using SPSS ver. 24., Results: In this study, the response rate was 85.3% (n=209). A majority of respondents had a positive attitude toward CAM (n=166, 79%), but their level of knowledge was limited (n=154, 73.6%). The most commonly used CAM modalities were herbal medicine (93.2%), exercise therapy (75.4%), and hydrotherapy (75.2%), respectively, and the least commonly used ones were magnetic therapy (2.9%) and hypnosis (4.8%). The most important reasons for the use of CAM modalities by HP included fewer side effects than medical treatments (57.4%), its lowest cost than medical treatments (34.9%), non-serious disease with no need for referral to a clinic (32.1%), and its more convenient access than medical treatments (30.6%). The results showed that there was a significant relationship between the education level and the use of CAM modalities (p<0.05). There was also a significant relationship between the suggestion of CAM modalities and the amount of use of these modalities, and those who used these modalities would also have recommended them to their clients more frequently (p<0.05)., Conclusion: The results showed that most of HP used at least one of the CAM modalities and had a positive attitude towards CAM. As the level of knowledge was limited, training courses should be implemented to increase health practitioner's level of knowledge on CAM., (© 2021. The Author(s).)

Background: Complementary and alternative veterinary medicine (CAVM) is becoming increasingly popular in horses., Methods: Online, cross-sectional survey in 1532 horse owners. Attitude towards CAVM, subjective norms, perceived behavioural control and intention for future CAVM use were measured based on the theory of planned behaviour. Structural equation modelling was performed to characterize factors influencing intention to use CAVM., Results: Past use of CAVM, predominantly manual therapies and herbal supplements, was reported by 72.5% of all participants. Frequently reported indications were improving horse's well-being, illness which did not resolve after conventional treatment and chronic illness. The attitude towards CAVM was positive with a median (interquartile range) score of 6 of 7 (4.75-7.00). Predictors for past CAVM use were higher owner age, alternative medicine self-use and higher education (non-university). The strongest predictor of future CAVM usage was perceived behavioural control and perceived CAVM efficacy, as well as positive attitude towards and perceived knowledge about CAVM. The veterinarian was reported as a source of information about CAVM by 86.4% of all participants., Conclusions: Horse owners showed a high intention to use CAVM with the owners' perceived behavioural control and perceived CAVM efficacy as the strongest predictor. Veterinarian-client communication is important to inform horse owners correctly., (© 2021 British Veterinary Association.)

Our study explored pre-nursing and graduating nursing students' experience with, knowledge of, and attitude toward complementary and alternative medicine (CAM). Both pre-nursing and nursing students reported positive attitudes toward CAM in general, indicated being interested in learning about CAM, and planned on making CAM practices part of their future careers., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

This study aimed to determine the prevalence of complementary and integrative health approach (CIHA) use in patients with heart failure (HF) and compare quality of life (QoL) between CIHA users and nonusers. This was a cross-sectional, descriptive, and comparative study including 130 patients with HF in Turkey. The data were collected using the sociodemographic and CIHA information form and the Kansas City Cardiomyopathy Questionnaire (KCCQ). The mean age was 64.51 ± 10.40 years. Furthermore, 26.1% of the participants had used at least one form of CIHA in the previous year. The most used CIHA was herbal therapies (94.2%). The total scores of the KCCQ were 47.70 ± 9.50 in the study, and a statistically significant difference was found in the total scores of the KCCQ between CIHA users and nonusers. The findings of this study revealed that more than a quartile of patients with HF used at least one form of CIHA. Further prospective studies are warranted to follow up with patients having HF who use any form of CIHA for a longer period and determine other parameters that directly influence QoL., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

This study was conducted to analyze health care personnel's attitudes toward traditional and complementary medicine (TCM) and life satisfaction due to coronavirus disease-2019 (COVID-19) pandemic. This cross-sectional descriptive study was conducted between April 2 and 9, 2020. The Questionnaire form was sent to health care personnel online. A total of 560 individuals who answered the questionnaires were included in the study. The data were collected by using the Personal Information Form, Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ), and Life Satisfaction Scale (LSS). Average age of the participants was 30.88 ± 7.68 years, 82.5% were male, and 65.5% were working as nurses. It was found that 45.5% of the participants used TCM methods for COVID-19 during the last month; 48.7% of the health care personnel stated that they used TCM methods to strengthen their immune system. The HCAMQ total average score was 27.96 ± 5.49; the holistic health subdimension total average score was 9.59 ± 3.04; the complementary and alternative medicine subdimension total average score was 18.37 ± 3.58; and the LSS total average score was 20.78 ± 6.32. A positive weak statistically significant association was found between the HCAMQ and complementary and alternative medicine subdimension and the LSS (P < .05). Participants had moderately positive attitudes toward TCM and life satisfaction. As the participants' positive attitudes toward TCM increased, their life satisfaction was also found to increase., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Physicians who include complementary medicine in their practice are thought to have an understanding of health and disease different from that of colleagues practicing conventional medicine. The aim of this study was to identify and compare the thoughts and concepts concerning infectious childhood diseases (measles, mumps, rubella, chickenpox, pertussis and scarlet fever) of physicians practicing homeopathic, anthroposophic and conventional medicine., Methods: This qualitative study used semistructured interviews. Participating physicians were either general practitioners or pediatricians. Data collection and analysis were guided by a grounded theory approach., Results: Eighteen physicians were interviewed (6 homeopathic, 6 anthroposophic and 6 conventional). All physicians agreed that while many classic infectious childhood diseases such as measles, mumps and rubella are rarely observed today, other diseases, such as chickenpox and scarlet fever, are still commonly diagnosed. All interviewed physicians vaccinated against childhood diseases. A core concern for physicians practicing conventional medicine was the risk of complications of the diseases. Therefore, it was considered essential for them to advise their patients to strictly follow the vaccination schedule. Homeopathic-oriented physicians viewed acute disease as a biological process necessary to strengthen health, fortify the immune system and increase resistance to chronic disease. They tended to treat infectious childhood diseases with homeopathic remedies and administered available vaccines as part of individual decision-making approaches with parents. For anthroposophic-oriented physicians, infectious childhood diseases were considered a crucial factor in the psychosocial growth of children. They tended to treat these diseases with anthroposophic medicine and underlined the importance of the family's resources. Informing parents about the potential benefits and risks of vaccination was considered important. All physicians agreed that parent-delivered loving care of a sick child could benefit the parent-child relationship. Additionally, all recognized that existing working conditions hindered parents from providing such care for longer durations of time., Conclusions: The interviewed physicians agreed that vaccines are an important aspect of modern pediatrics. They differed in their approach regarding when and what to vaccinate against. The different conceptual understandings of infectious childhood diseases influenced this decision-making. A survey with a larger sample would be needed to verify these observations.

Background: About 70% of Ghanaians depend on traditional, complementary and integrative medicine (TCIM) practices for primary healthcare needs. It was therefore integrated into mainstream healthcare delivery system by the Ministry of Health in September 2012. LEKMA hospital was one of the institutions for piloting TCIM services. We assessed factors that promote the usage and sustainability of TCIM services within the formal healthcare system., Methods: We conducted a cross-sectional study from April-June 2017 at the LEKMA hospital, Accra, Ghana. Patients and managers of TCIM clinic were interviewed. Data was collected through qualitative and quantitative approaches. We defined usage of TCIM as its current use, and sustainability as structures in place to run TCIM services. For assessing usage, a five-point Likert scale was used to assess five domain areas via exit interviews. Managers were assessed on the sustainability of TCIM services through in-depth interviews. Likert scales responses were analysed quantitatively using descriptive tertile statistics. Thematic analysis was used for qualitative analysis., Results: Overall, 72.7% (40/55) of the clients showed a high preference for TCIM usage and 80.0% (4/5) of the managers valued it as partially sustainable. Eighty per cent (44/55) of patients indicated that the location of TCIM services and availability of visible directional signs influenced the good usage; 84% (46/55) of the patients agreed that the usage of TCIM was influenced by their perceived effectiveness. Managers indicated that human resources for providing services was a challenge and TCIM integration into the operations of the hospital needed to be improved., Conclusion: We observed a high preference for usage of TCIM among users at LEKMA hospital. The general belief in the potency, perceived effectiveness, location and availability of TCIM services are key determinants of the high preference for usage of TCIM. Provision of TCIM services in its current form is partially sustainable from the managers' perspective. We recommend that the Ministry of Health ensures the availability of staff and create awareness of TCIM services among the general populace.

Objective: To describe the use of complementary and alternative medicine (CAM) in pediatric functional abdominal pain disorders at a large Midwestern pediatric gastroenterology center., Study Design: A survey of patients attending a follow-up visit for functional abdominal pain disorders was completed. Data were collected on demographics, quality of life, use of conventional therapies, patient's opinions, and perception of provider's knowledge of CAM., Results: Of 100 respondents (mean age, 13.3 ± 3.5 years), 47 (60% female) had irritable bowel syndrome, 29 (83% female) had functional dyspepsia, 18 (67% female) had functional abdominal pain, and 6 (83% female) had abdominal migraine (Rome III criteria). Ninety-six percent reported using at least 1 CAM modality. Dietary changes were undertaken by 69%. Multivitamins and probiotics were the most common supplements used by 48% and 33% of respondents, respectively. One-quarter had seen a psychologist. Children with self-reported severe disease were more likely to use exercise (P < .05); those with active symptoms (P < .01) or in a high-income group (P < .05) were more likely to make dietary changes; and those without private insurance (P < .05), or who felt poorly informed regarding CAM (P < .05), were more likely to use vitamins and supplements. Seventy-seven percent of patients described their quality of life as very good or excellent., Conclusions: The use of CAM in children with functional abdominal pain disorders is common, with a majority reporting a high quality of life. Our study underscores the importance of asking about CAM use and patient/family knowledge of these treatments., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Presence and therapeutic listening are complementary therapies that are incorporated into daily nursing practice. This article presents the nurse's role in facilitating complementary therapies of presence and therapeutic listening, barriers encountered, and the behaviors and techniques to be used. Also discussed is the impact that using presence and therapeutic listening has on patient outcomes. These interventions have the potential to significantly alter patients' perceptions of care and improve patient outcomes. Presence and therapeutic listening are vital to developing a therapeutic nurse-patient relationship. This relationship is what drives positive patient outcomes and increases overall satisfaction and quality of care., Competing Interests: Disclosure Neither Dr D.L. Ellison or Mrs C.K. Myer has any commercial or financial conflicts of interest or any funding sources relevant to this article., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: The use of complementary and alternative medicine (CAM) in dermatology has been increasing in recent years. Patterns of CAM use by vitiligo patients have not previously been assessed in Saudi Arabia. Therefore, it is worth exploring the perceptions, knowledge, and attitudes of Saudi vitiligo patients toward CAM., Methods: A cross-sectional study was conducted for 12 months among Saudi vitiligo patients at King Abdulaziz Medical City in Riyadh. A validated self-administered questionnaire, comprised of four sections, was used to collect the data. Descriptive analysis was used, and a chi-squared test was used to determine the association between dependent and independent variables., Results: Two hundred patients with vitiligo were enrolled, 56% of whom were female. The average age was 31.6 ± 15.45 years. Approximately 52% of the patients were either current or previous users of CAM. Among the patients, 44.5% had been asked by their dermatologist about their CAM use, and 18.5% preferred not to disclose their CAM use. Social media was the most common source of information for CAM (28%)., Conclusion: More than half of the vitiligo patients in our study used some form of CAM. The most popular remedies were honey (37%), Nigella sativa (29%), and olive oil (29%).

Background: Australians report consulting with a naturopaths or herbalists to improve their wellbeing, yet little is known about the associations between these consultations and the patients' health behaviours. This cross-sectional study aimed to examine the relationship between health behaviour and consultations with naturopaths or herbalists in three age cohorts of Australian women., Methods: Women aged 19-25 years, 31-36 years, and 62-67 years from the Australian Longitudinal Study on Women's Health (ALSWH) were surveyed regarding smoking, alcohol or drug use, physical activity and dietary behaviour; and whether they consulted with naturopath/herbalists in the last 12 months. Associations were analysed using multivariable logistic regression., Results: A total of 9151 (19-25 years), 8200 (31-36 years) and 11,344 (62-67 years) women were included in the analysis. Between 7.3 and 11.9% of women reported to have consulted with naturopaths/herbalists in the last 12 months. Women of all cohorts consulting with naturopath/herbalist were less likely to smoke (19-25 yrs.: Odds Ratio [OR] 0.61; 31-36 years: OR 0.58; 62-67 years: OR 0.29), more likely to report at least moderate levels of physical activity (19-25 yrs.: OR 1.41; 31-36 years: OR 1.34; 62-67 years: OR 1.34), and the use of vegetarian diets(19-25 yrs.: OR 1.40; 31-36 years: OR 1.77; 62-67 years: OR 2.28), compared to women not consulting with naturopaths/herbalists. Women consulting with naturopaths/herbalists however were also more likely to have used marijuana (19-25 yrs.: OR 1.18; 31-36 years: OR 1.42), or illicit drugs in the last 12 months (19-25 yrs.: OR 1.24; 31-36 years: OR 1.40)., Conclusions: Consultations with a naturopath or herbalist are associated with positive health behaviours that are protective of internationally important non-communicable diseases. Psychoactive drug use is also reported among women visiting a naturopath or herbalist. Further research is needed to understand the role naturopaths play in advising patients with regards to health and non-healthy behaviours.

Background: Integrating complementary medicine into medical care promotes patient-oriented care. A well-informed and collaborative professional healthcare team is essential for effective and patient-safe implementation of these methods. At present, the skills for patient counseling, therapy and care regarding complementary medicine vary among the professional groups involved. Professionals generally feel that they are not sufficiently qualified in this area. Curricular concepts for Complementary and Integrative Medicine (CIM) are virtually non-existent in undergraduate interprofessional training. The aim of this study is to initiate a consensus-building process between various experts (professionals, students, patient and faculty representatives) in order to identify which topics should be the focus of such a curriculum., Methods: A three-round Delphi study was carried out from March 2018 to March 2019 to compile the experience and knowledge of experts in the field of integrative patient care and interprofessional education. Sixty-five experts from Germany and German-speaking Switzerland with various professional backgrounds and experiences were asked to name general content, therapy methods and treatment reasons which should be addressed in interprofessional seminars. In the subsequent rounds these were rated on a seven-point Likert scale. The ratings were assigned to relevance groups and discussed in a final workshop in July 2019., Results: The response rates for the three rounds were 76% (n = 50), 80% (n = 40) 90% (n = 36); and 21% (n = 11) for the final workshop. The experts suggested that topics could be aligned along the most common treatment reasons such as insomnia, generalized pain, fatigue and back pain. However, it is important that students also receive an overview of the evidence base for different therapeutic concepts, especially in the field of classical natural medicine, acupuncture and mind-body medicine, and that they get an overview of the effects and interactions of frequently used procedures., Conclusion: Consensus was reached among the various experts on the most important topics for an interprofessional CIM curriculum. The systematic evaluation of the topics in this study can help to create a curriculum that achieves a high level of acceptance among teachers, lecturers and students, and thus facilitates implementation at universities and medical faculties.

Objective: Wilderness therapy (WT) is a complementary/integrative approach for treating struggling adolescents by using outdoor adventure activities to foster personal and interpersonal growth/well-being. Empirical support for the effectiveness of traditional WT is growing, but evidence supporting trauma-informed WT (TIWT) is lacking. This pilot study addresses that gap. Method: Between 2009 and 2019, 816 adolescents (Ages 13-17, M age = 15.36, SD = 1.25; 41.1% female) completed the Youth-Outcome Questionnaire-SR 2.0 at intake and discharge ( M = 75.02 days, SD = 28.77). Three-hundred seventy-eight adolescents also completed the Family Assessment Device-General Functioning (FAD-GF), and 253 adolescents completed two, 2.5-min segments of heart-rate-variability biofeedback (one while resting and one while using a coping skill). One-hundred eighty-nine caregivers completed the Youth-Outcome Questionnaire 2.01, and 181 caregivers completed the FAD-GF. Between 25 and 99 adolescents and caregivers also completed psychological and family measures at 6 months and 1 year postdischarge. Results: Adolescents reported experiencing improvements in psychological and family functioning. They also exhibited improvement in psychophysiological functioning (heart-rhythm coherence). Caregivers reported improvements in family functioning and their child's psychological functioning. Caregivers observed more persisting benefits in their child's psychological functioning, whereas adolescents reported more persisting benefits in family functioning. Changes in psychological and family functioning were related. There were very few differential effects on the basis of demographic factors, trauma exposure, or past and current treatment factors. Conclusion: Results of this pilot study suggest TIWT is a promising complementary/integrative intervention for improving the psychological, family, and psychophysiological functioning of struggling adolescents. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Purpose: Many patients with cancer are interested in complementary therapies, including strategies such as reduced carbohydrate diets. Guidelines regarding the use of these diets during cancer treatment are lacking; therefore, we aimed to explore the perceptions and practices of medical oncologists in Canada regarding low-sugar and ketogenic diets., Method: A cross-sectional, online multiple-choice survey was distributed to 206 Canadian medical oncologists. Questions explored frequency of patient interactions, oncologist perceptions of efficacy, advice given to patients, and concerns about side effects related to reduced carbohydrate diets., Results: Responses were received from 57 medical oncologists in seven of thirteen provinces and territories, with an overall response rate of 28%. Forty-nine percent of respondents were asked at least weekly about a low-sugar diet, and 9% about the ketogenic diet. Eighty-five percent supported the use of a low-added sugar diet in patients with diabetes or hyperglycemia, while conversely 87% did not support the use of a ketogenic diet for any of their patients undergoing active cancer treatment. Respondents felt either that a ketogenic diet was not effective (31%) or that the effect on cancer outcomes was unknown (69%). Ninety-six percent of respondents had concerns about a ketogenic diet for patients receiving active cancer treatment., Conclusion: The role of reduced carbohydrate diets during cancer treatment is topical. Canadian oncologists are particularly reluctant to support a ketogenic diet for patients on active cancer treatment, with concerns about side effects and unknown efficacy. There may be a role for continuing medical education and institutional guidelines to inform these discussions with patients.

Background: The use of complementary and alternative medicines (CAM) has been reported to be frequent and increasing in the general population and among cancer survivors. Very few studies have investigated the use of CAM among long-term endometrial cancer survivors. To address this gap in evidence, this qualitative study aimed to understand the use of CAM and factors motivating the use among long-term survivors of endometrial cancer., Methods: Semi-structured qualitative interviews were conducted with 17 women diagnosed with endometrial cancer 7-10 years previously, to understand their CAM use and its impact on their wellbeing. Thematic analysis was performed by two researchers to extract the most relevant quotes related to CAM products, practices, and practitioners., Results: All 17 women interviewed used some type of CAM practices, practitioners, or products, specifically 94% concentrated on their diet, 88% focused on their exercise, 59% used a CAM product, 53% visited a CAM practitioner, and 18% used a CAM psychological approach. The main motivators for CAM use included to reduce physical and psychological symptoms, and to stop or reduce medications. Women reported a lack of lifestyle advice from their traditional medical healthcare team which they therefore tried to obtain from other sources., Conclusions: Our findings suggest CAM practices, practitioners, or products form an important part of women's healthcare options and are commonly used by long-term endometrial cancer survivors. Our data can be of importance to health care professionals and hospitals, as it reflects an unfulfilled need among cancer survivors that does not currently appear to be met by their traditional healthcare team.

Background Systematic analysis of the determinants of choice of a treatment modality aids to the understanding of decision process of healthcare utilization. The revealed preference of a single modality may differ according to the nature of disease. Existing studies have not integrated possible causal factors in a model with respect to diseases. This study identifies major determinants and formulates their integral effect on choice of a particular modality on acute and chronic diseases in accordance to socio-behavioural model. Methodology A cross-sectional study on 300 samples using a 30-point questionnaire, developed in Likert scale and dichotomous scale. Possible determinants are tested on choice of CAM in case of acute disease and of chronic disease separately. Results Revealed single modality treatment preference (of CAM) varies widely between acute disease (13%) and chronic disease (58.67%). Bivariate associations are significant for gender (For, overall CAM preference, p=0.001, acute disease, p<0.001, chronic disease, p=0.024), Disease burden (overall and chronic: p<0.001, acute: p=0.008) and previous CAM usage (overall and chronic: p<0.001, acute: p=0.016). Social factor individually has significant influence on choosing CAM both acute (OR=1.096, p<0.001) and chronic disease (OR=1.036, p<0.001). Ideation of philosophical need factor, guided by philosophical congruence with CAM (OR=1.047, p<0.001) is a novel finding of this study. While with multiple logistic regression male gender (p=0.03), social factor (p<0.001), perception of CAM efficacy (p=0.02) and negative ideation about CAM cost-effectiveness (p=0.002) are found to be important in Acute disease; choosing CAM in chronic disease is guided by female gender (p=0.001), making decision in-group (p=0.001), low disease burden (p<0.001), philosophical need factor (p=0.001), and perception of CAM efficacy (p<0.001). Conclusion Demographic, social, cognitive and philosophical factors are important determinants of choosing CAM as a treatment modality over conventional medicine, but they act differently on CAM preference in acute and chronic diseases.

The aim of this study was to examine the complementary and alternative medicine (CAM) experiences of patients with constipation irritable bowel syndrome (IBS-C). This qualitative study consisted of a total of 30 patients, who were admitted to a university hospital in Turkey. Data were collected using a descriptive questionnaire and a semistructured interview. Data analysis identified 5 main themes: (1) constipation-related difficulties experienced due to IBS, (2) the feeling that the CAM use is natural and useful, (3) the effect of the environmental stimuli in preferring the use of CAM, (4) the feeling that CAM is not negative and relieves, and (5) suggesting the CAM use. In conclusion, it was determined that all the patients with constipation IBS used various CAM methods. It may be recommended to raise the awareness of the patients by health care professionals about the CAM methods that may be useful., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Complementary and Alternative Medicine (CAM) is commonly and increasingly used in America and worldwide and can include both pharmacologic (e.g., vitamins and supplements) and nonpharmacologic (e.g., yoga) interventions. These therapies may be of interest to patients who desire "natural" alternatives or complements to standard treatments. CAM may be used by patients, with or without supervision from a licensed medical professional, to treat psychiatric conditions., Objective: To provide an overview of more commonly used CAM interventions that have relevance to mental health care providers, particularly consultation-liaison psychiatrists, and to describe the indications, safety, and dosing of these treatments., Methods: We searched PubMed to identify articles that described the uses, safety, mechanisms, and recommendations for CAM therapies in relation to the treatment of psychiatric conditions. Articles most relevant to this review were included, with a preferential focus on meta-analyses and systematic reviews., Results: We summarized common CAM therapies that have shown efficacy for the treatment of psychiatric conditions. These therapies include natural medications, nutritional psychiatry, light therapy, yoga, and exercise., Conclusions: Certain CAM interventions may be effective as monotherapies and/or as adjunctive treatments for psychiatric conditions. However, they may also have safety risks, contraindications, and/or interactions with medications. It is therefore important for physicians and other mental health care professionals to inquire about patient use of CAM and to understand the indications, safety, and dosing of these therapies., (Copyright © 2020 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: The aim of our study was to investigate the differences in beliefs, attitudes toward CAM, beliefs in afterlife and religiosity among the sample of psychiatrists, psychologists, and theologists. Relationship among these constructs could have impact on the concept of mental health., Subjects and Methods: Research was conducted in the Split urban area, Croatia, during 2017 on a sample of psychiatrists (n=51), psychologists (n=55), and theologists (n=25). Participants were presented a figure of the human body, which contained numbers identifying eight different regions of the body. Participants were asked to select which region best represents the location of the self, soul, and mind in the body. We used CAIMAQ (The Complementary, Alternative and Integrative Medicine Attitudes Questionnaire) which contains five subscales. The Afterdeath Beliefs Scale was used to measure the varieties of afterlife beliefs. Analyses showed that applied questionnaires have appropriate reliability and expected factor structure., Results: The most frequent locations of the Soul were 9 (37%, Not located in any centralized region in the body) and 5 (31% chest), whereas Self and Mind were mostly located in the head (43% and 73%). Psychiatrists and psychologists have average scores on positive pole of CAIMAQ but did not differ significantly (p>0.05). There were statistical differences between theologists and psychologists/psychiatrists on two subscales: "nutritional counseling and dietary/food supplements can be effective in the treatment of pathology" and "attitudes toward a holistic understanding of the disease" (p<0.05). There were significant correlations between religion and three CAIMAQ subscales. Although they were mostly religious, psychiatrists and psychologists had a higher average score on Annihilation than theologists. They also did not believe in body resurrection and connection between behavior during life and after death., Conclusion: The results of our study could have impact on the concept of mental health and in the future must be deeper evaluated within qualitative research methodology.

Older people are at risk of developing multi-comorbidity and thus being exposed to multiple treatments and drugs to manage the emerging health complaints. More focus has been put on nonpharmacological alternatives. However, studies revealing the healthcare staff perspective on using nonpharmacological methods (NPMs) in the care of older people are still lacking. Thus, the aim of this study was to map the use of NPMs in daily practices and the follow-up thereof. A population-based survey with questionnaires was performed, included all healthcare professionals (n = 163; nurses and paramedical professionals) working in one district of elderly care in Sweden. The older person's anxiety and worry (76.1%), sleeping problems (53.1%) and pain (41.1%) were the health problems in daily life most likely to trigger use of NPMs. To manage the emerging health problems, interactions (87.1%), diet and nutrition supplements (63.2%) and physical activity were commonly used, particularly by nurses. One third (n = 54) stated that they did not evaluate the NPMs used, with no statistical differences between nurses and paramedical professionals. The present study indicated that NPMs were used in care of older people among nurses and paramedical professionals, but not in a systematic way and often without follow-up., (© 2019 Nordic College of Caring Science.)

The popularity of complementary and alternative medicine (CAM) appears to be increasing, especially among college students. We surveyed 146 undergraduate and graduate students with the CAM Health Belief Questionnaire and obtained credibility and frequency ratings for a select group of CAM therapies: yoga, meditation, massage, chiropractic medicine, biofeedback, hypnosis, acupuncture, spirituality/religion, therapeutic touch, the use of herbs/vitamins, and aromatherapy/essential oils. Graduate students held more favorable views about integrating CAM into conventional medical practice. Female students reported using a wider variety of therapies than male students. Spirituality/religion and herbs/vitamins were the most popular CAM approaches. Students rated yoga, meditation, and massage as being highly credible practices. They rated hypnosis and therapeutic touch low in credibility. We discuss hypnosis as an example of a therapy that suffers from poor public perception despite having a relatively strong evidentiary base.

Background We examined the influence of companionship and the use of complementary therapies on adverse outcomes in parturients under regional analgesia. Methods This study is a single-center retrospective cohort of 986 term pregnant women, and it was based on data from medical records (hospitalization period: November 2012-November 2018). The women were in the active phase of labor under regional analgesia. A statistical program was used to search for an association between companionship and the use of complementary therapies with sample data. Bi- and multivariate logistic regressions based on significant associations were used to analyze the potential intervening variables in the adverse outcomes. Results Models were constructed for each of the maternal adverse outcomes. Childbirth complications were significantly associated with complementary therapies [adjusted odds ratio (AOR) = 0.42; 95% confidence interval (CI) = 0.28-0.63; P < 0.001] and companionship (AOR = 0.36; 95% CI = 0.22-0.57; P < 0.001). Prolonged maternal hospitalization was significantly associated with companionship (AOR = 0.57; 95% CI = 0.36-0.92; P < 0.05). Unplanned cesarean section showed a significant association with complementary therapies (AOR = 0.05; 95% CI = 0.01-0.47; P < 0.01). Conclusion The likelihood of childbirth complications and prolonged maternal hospitalization is reduced by companionship, whereas the likelihood of childbirth complications and cesarean section rates is reduced by the use of complementary therapies.

Background: Complementary and alternative medicine (CAM) is used often by patients with different diseases. While some authors subsume religiousness and spirituality to CAM, others do not. The objective of the present study was to assess the prevalence and types of CAM usage as well as the participants' spirituality/religiousness in an outpatient department for endocrinology and metabolic diseases., Methods: All individuals visiting the outpatient department at a German university hospital from April to June 2009 were offered a standardized questionnaire on the use of dietary supplements and alternative therapies as well as their religiousness/spirituality. Demographic and clinical data of 428 respondents were taken from the electronic health record., Results: Of the respondents, 16.4% (n = 66) classified themselves to be religious/spiritual and 67.9% (n = 273) as not religious/spiritual. Women were more religious/spiritual than men (p = 0.02). 41.4% of the respondents used supplements and 27.4% additional therapies. The use of supplements and additional therapies was more frequent in people with higher religiousness/spirituality (p = 0.005 and p = 0.01,resp.) but there were no associations between religiousness/spirituality and the number of consultations, costs for drugs, appraisal of the physicians treatment methods, the perceived effectiveness of prescribed drugs, fear of late complications or of side effects., Conclusions: A higher religiousness/spirituality is associated with a more frequent use of supplements or additional therapies in individuals with endocrinopathies or metabolic diseases. As CAM has been shown to be associated with worse outcome, addressing religiousness/spirituality which stresses the responsibility of the person for his life might offer an additional resource and should be further studied., (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)

Complementary and alternative medicine (CAM) approaches are widely used by patients throughout a broad range of medical fields and diseases, and often self-administered by patients without the involvement of physicians or other members of the health care team. CAM use is well documented in cancer and chronic illnesses, and emerging data in radiation oncology show CAM usage of 26% to 97% in radiation therapy patients. No information is, however, available on CAM usage in radiology and in the imaging procedure fields. This article reviews the fundamental principles and the experience with the wide spectrum of CAM in radiation oncology-a field that shares many parallels with radiology, such as prevalence of imaging, procedural requirements, and cooperation demanded from patients.CAM is defined as "approaches and practices that are typically not part of conventional medical care," and includes the use of mind- and body-based practices (eg, meditation, massage, acupuncture), natural products (eg, herbs, vitamins, minerals), and other interventions. Supplements are used frequently to alleviate side effects of therapy and promote overall well-being. Specifically, the mindfulness/meditation approaches of CAM are known to reduce anxiety and enhance physical and emotional wellbeing in patients with chronic diseases, such as cancer or neurologic diseases, through physiological, psychological, and perhaps placebo mechanisms. Such patients often require repetitive and invasive imaging examinations or procedures, such as for cancer treatment, cancer surveillance/follow-up, or monitoring of chronic diseases, for example, surveillance MRI in multiple sclerosis. Such parallels suggest that the vastly understudied area of CAMs deserve further investigation in both the radiation oncology and the imaging fields. Further research on CAM is needed to develop refined recommendations and national/and international guidelines on its use.

Objective: This study explored older people's knowledge, experience and perception of complementary and alternative medicine (CAM) and acupressure, and their willingness to accept acupressure., Method: This qualitative descriptive study, using semi-structured interviews, was conducted at two residential aged care facilities. Thematic analysis was used to analyse the data., Results: Fifteen older people participated. Participants had limited knowledge about CAM and acupressure. Many of them had positive views on CAM, and were willing to accept acupressure. There were five major themes: knowledge and understanding about CAM, experience of using CAM, general views on use of CAM, reasons for not using CAM, and willingness to accept acupressure., Conclusion: The findings show the diverse views on CAM and acupressure from the perspectives of the older people in this study. There is a need for further research investigating the usefulness of CAM and acupressure in aged care settings., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Dermatology patients are expressing a growing interest in complementary and alternative medicine (CAM) and natural treatment options for management of dermatologic conditions. Counseling on the optimal integration of CAM with conventional therapeutic approaches can be daunting for practitioners who do not feel well-versed in these modalities. A productive conversation between the clinician and patient seeking natural treatments should address the appropriate role and scope of CAM in a therapeutic plan, which is best suited for use as maintenance therapy or to augment traditional pharmaceutical or procedural interventions. Understanding the patient's goals, discussing evidence-based conventional and complementary treatment options, and employing shared decision making can enhance the clinical encounter and strengthen the physician-patient relationship., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Acute respiratory tract infection (ARTI) is a prevalent condition associated with serious health and economic implications. A range of strategies is used to manage ARTI in children, including complementary and alternative medicines (CAM). There has been little investigation into this area, and this study aims to address this knowledge gap., Methods: Primary carers of children aged from 0 to 12 years that utilised CAM for ARTI were invited to participate in the online survey in 2019. Survey data were analysed descriptively., Results: The 246 surveyed parents specified the types of CAM frequently used to manage ARTI in their children were home-remedies. Reasons parents reported using CAM were personal-beliefs and positive past-experience with CAM practitioners. Information sources that parents consulted when decision-making were education, naturopaths, and journals., Conclusion: Parents utilised diverse interventions, with home-remedies dominating the choice. Parents were most likely well-informed. Notably, parents indicated a preference for an integrative healthcare approach., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The present study focuses on the identification of profiles of CAM believers and/or users. Using data from the Spanish CIS Barometer (2018) and a sample of 2486 Spaniards, a hierarchical and non-hierarchical cluster analysis and discriminant analysis have been performed. Profiles of people with a high level of belief in CAM and/or CAM users were identified. Results reflect relationships between personal factors (healthy lifestyle and status, political and religious ideology) and satisfaction with conventional medicine with the belief/use of CAM. Personal factors and satisfaction are not related to the level of belief in CAM. We have tried to fulfil some gaps detected in the literature: much of the research has been methodologically limited and there is a need to deepen the study of factors and processes that favor the initial uptake and subsequent use of CAM. Doing this, this paper offers diverse recommendations for organizations worried about this theme., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: The relationship between obesity and various chronic diseases is well documented. In Jordan, the prevalence of overweight (30.0%) and obesity (38.8%) among females is on the rise, encouraging many adults to rely on alternative health care methods to manage their weight., Aims: We explored the status of complementary and alternative medicine use for weight management among adult females in Jordan and the possible relationship between complementary and alternative medicine use and body mass index., Methods: An interviewer-administered, structured questionnaire was used to collect data on the use and safety of complementary and alternative medicine for weight management from 858 women in 2015. Responses were coded and analysed using SPSS, version 20., Results: Around 40% of the respondents reported using some form of complementary and alternative medicine for weight management. Commercial dietary supplements (31.2%), herbal remedies (26.7%) and folk remedies (18.0%) were commonly used. Green tea and fibre tablets were the most widely used herbal supplements. Logistic regression analysis indicated that overweight participants are more frequent complementary and alternative medicine users compared to obese. Relatives and friends were the main sources of information about complementary and alternative medicine. Only 31.9% of women believed that complementary and alternative medicine modalities were safe; around half believed they were not safe during pregnancy (52.5%) and lactation (48.0%). Only 49.7% were aware of side-effects and 41.5% of drug interactions., Conclusion: This study revealed that complementary and alternative medicine is often used for weight management. Awareness of the safe use of complementary and alternative medicine with other medications and during pregnancy and lactation should be addressed., (Copyright © World Health Organization (WHO) 2020. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)