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The UK government has invested £5.77 million in green social prescribing to prevent and tackle mental ill-health. Therapeutic community gardening, one type of green social prescription, provides a range of health outcomes. However, for increased accessibility, a greater understanding of how it impacts mental health and the facilitators and barriers to referral, uptake, and attendance by individuals with mental health problems is required. We conducted and thematically analysed interviews with thirteen stakeholders including social prescribing link workers and garden staff; and focus groups with twenty garden members. The mechanisms by which therapeutic community gardening were suggested to impact mental health were by engaging members with nature and the outdoors, providing hope for the future and facilitating social support and relationships. Factors facilitating referral, uptake, and attendance included a holistic and person-centred approach, which is flexible around health needs. Barriers included awareness of the full offering of therapeutic community gardens and accessibility, in terms of physical location and waiting lists. Given that nature-based interventions have the potential to protect and enhance population health and offer cost savings through reduced reliance on other health services; overcoming these barriers is key to ensuring that therapeutic community gardening is more widely available as an additional mental health treatment.

INTRODUCTION: Patients may experience late complications following surgical treatment for colorectal and anal cancer, and we need instruments in Danish to plan treatment and person-centred follow-up treatment approaches. For this purpose, we chose the Measure Yourself Medical Outcome Profile (MYMOP) and Measure Yourself Concerns and Wellbeing (MYCaW). The aim of this study was to translate the two instruments into Danish and conduct a subsequent qualitative validation.METHODS: The translation process consists of five stages: forward translation, synthesis, back translation, expert panel review and pretesting. Qualitative validation included interview with target audience representatives, testing of face-validity and evaluation by lay persons.RESULTS: Through the translation process and qualitative validation, we produced Danish versions of the MYMOP and the MYCaW.CONCLUSIONS: The Danish versions of the two questionnaires are now ready for use in clinical practice and research after individual licensing consultation with the copyright holders.FUNDING: none.TRIAL REGISTRATION: not relevant.

The importance of Social Prescribing (SP) has been highlighted in the National Health Service (NHS) Long-Term Plan. SP is enabling healthcare professionals to refer patients to a link worker, to co-design a non-clinical social prescription to improve their health and well-being. Our aim was to explore perceptions, understanding, and awareness of SP amongst United Kingdom (UK) medical students.Views were collected using pre- and post-session surveys around teaching sessions in 27 UK medical schools as part of NHS England's National SP Student Champion Scheme. Pre-session surveys suggested 93% (n = 848) of respondents had not heard of the concept of SP before the session. Post-session surveys highlighted that 98% (n = 895) regarded the concept as useful and relevant to their future careers.Findings show a lack of awareness regarding Social Prescribing (SP) amongst UK medical students. New strategies are needed to ensure the doctors of tomorrow are equipped with the necessary tools to achieve the recent outcomes for graduates and implement plans for the NHS and general practice which highlight the importance of personalised care. We believe general practice can play an integral role in shaping values and beliefs amongst tomorrow's doctors through formal education and mentoring.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Social prescribing is an approach that aims to improve health and well-being. It connects individuals to non-clinical services and supports that address social needs, such as those related to loneliness, housing instability and mental health. At the person level, social prescribing can give individuals the knowledge, skills, motivation and confidence to manage their own health and well-being. At the society level, it can facilitate greater collaboration across health, social, and community sectors to promote integrated care and move beyond the traditional biomedical model of health. While the term social prescribing was first popularised in the UK, this practice has become more prevalent and widely publicised internationally over the last decade. This paper aims to illuminate the ways social prescribing has been conceptualised and implemented across 17 countries in Europe, Asia, Australia and North America. We draw from the 'Beyond the Building Blocks' framework to describe the essential inputs for adopting social prescribing into policy and practice, related to service delivery; social determinants and household production of health; workforce; leadership and governance; financing, community organisations and societal partnerships; health technology; and information, learning and accountability. Cross-cutting lessons can inform country and regional efforts to tailor social prescribing models to best support local needs. publishersversion published

Social prescribing allows health professionals to refer at risk patients toward health and wellbeing interventions and activities in the local community. It is a key part of NHS (National Health Service) England health care policy, and schemes based on the social prescribing model have been developed in countries including Canada, New Zealand, the Netherlands and Singapore. In this chapter, we consider the role that social prescribing can play in reducing stress related problems and supporting and encouraging self-care and self-management of conditions for which conventional medicine may not be the only or the best option. Drawing on primary and secondary data sources, we examine the scope of social prescribing and professional and service users' perspectives concerning its strengths and limitations. Our findings suggest that link worker meetings within social prescribing schemes can motivate people to pursue activities with mental, physical and social benefits such as exercise, artistic pursuits and gardening. Problems within schemes included health provider engagement, recruiting those with low agency and communication between professionals and patients about social prescribing. Based on our findings, we propose a number of recommendations for enhancing social prescribing schemes. Professionals, including neurologists, we argue, can benefit from engaging in the concept and practice of social prescribing and referring patients and clients to social prescribing link workers where appropriate. Neurologists are also part of a larger team, as they work alongside allied health professionals such as occupational therapists and physiotherapists, some of whom are already performing aspects of the link worker role.

Purpose Measure Yourself Concerns and Wellbeing (MYCaW) is a validated person-centred measure of the concerns and wellbeing of people affected by cancer. Research suggests that the concerns of informal caregivers (ICs) are as complex and severely rated as people with cancer, yet MYCaW has only been used to represent cancer patients’ concerns and wellbeing. This paper reports on the development of a new qualitative coding framework for MYCaW to capture the concerns of ICs, to better understand the needs of this group. Methods This multicentred study involved collection of data from ICs receiving support from two UK cancer support charities (Penny Brohn UK and Cavendish Cancer Care). Qualitative codes were developed through a detailed thematic analysis of ICs’ stated concerns. Results Thematic analysis of IC questionnaire data identified key themes which were translated into a coding framework with two overarching sections; (1) ‘informal caregiver concerns for self’ and (2) ‘informal caregiver concerns for the person with cancer’. Supercategories with specific accompanying codes were developed for each section. Two further rounds of framework testing across different cohorts allowed for iterative development and refinement of the framework content. Conclusions This is the first person-centred tool specifically designed for capturing IC’s concerns through their own words. This coding framework will allow for IC data to be analysed using a rigorous and reproducible method, and therefore reported in a standardised way. This may also be of interest to those exploring the needs of ICs of people in other situations.

Social prescribing allows health professionals to refer at risk patients toward health and wellbeing interventions and activities in the local community. It is a key part of NHS (National Health Service) England health care policy, and schemes based on the social prescribing model have been developed in countries including Canada, New Zealand, the Netherlands and Singapore. In this chapter, we consider the role that social prescribing can play in reducing stress related problems and supporting and encouraging self-care and self-management of conditions for which conventional medicine may not be the only or the best option. Drawing on primary and secondary data sources, we examine the scope of social prescribing and professional and service users' perspectives concerning its strengths and limitations. Our findings suggest that link worker meetings within social prescribing schemes can motivate people to pursue activities with mental, physical and social benefits such as exercise, artistic pursuits and gardening. Problems within schemes included health provider engagement, recruiting those with low agency and communication between professionals and patients about social prescribing. Based on our findings, we propose a number of recommendations for enhancing social prescribing schemes. Professionals, including neurologists, we argue, can benefit from engaging in the concept and practice of social prescribing and referring patients and clients to social prescribing link workers where appropriate. Neurologists are also part of a larger team, as they work alongside allied health professionals such as occupational therapists and physiotherapists, some of whom are already performing aspects of the link worker role.

Introduction. Improved models of care are needed to meet all the support needs of people with cancer, which encompass psychological, emotional, physical, spiritual, sexual, occupational, social and existential needs. The aim of this article is to ( a) evaluate short- and long-term impacts of using a whole person approach to support people with cancer on the Living Well with the Impact of Cancer Course (LWC) and ( b) use these data to inform strategic decisions about future service provision at Penny Brohn UK. Methods. Longitudinal mixed-methods service evaluation (n = 135). Data collected included health-related quality of life (HRQoL) (FACIT-SpEx); Concerns (types and severity–MYCaW); lifestyle behavior (bespoke questionnaire), and participants’ experiences over 12 months postcourse. Results. Statistically and clinically significant improvements from baseline to 12 months in severity of MYCaW Concerns (n = 64; P < .000) and mean total HRQoL (n = 66; P < .000). The majority of MYCaW concerns were “psychological and emotional” and about participants’ well-being. Spiritual, emotional, and functional well-being contributed most to HRQoL improvements at 12 months. Barriers to maintaining healthy lifestyle changes included lack of support from family and friends, time constraints, and returning to work. Three to 6 months postcourse was identified as the time when more support was most likely to be needed. Conclusions. Using a whole person approach for the LWC enabled the needs of participants to be met, and statistically and clinically significant improvements in HRQoL and MYCaW Concerns were reported. Qualitative data analysis explored how experiencing whole person support enabled participants to make and sustain healthy lifestyle changes associated with improved survivorship. Barriers experienced to making health behavior change were also identified. These data then informed wider and more person-centered clinical provision to increase the maintenance of positive long-term behavior changes. Comparison of whole person approaches to cancer treatment and support and standard care are now urgently needed.

Background: In 2014 The National Institute for Health and Care Excellence (NICE) called for development of a system to collate local data on exercise referral schemes (ERS) to inform future practice. This database would be used to facilitate continued evaluation of ERS. ‘Big data’ analytics is a current trend in healthcare with the potential to influence decision making. Indeed, the use of health databases can spur scientific investigation and generation of evidence regarding healthcare practice. NICEs recommendation has not yet been met by public health bodies. However, through collaboration between ukactive, ReferAll, a specialist in software solutions for exercise referral, and the National Centre for Sport and Exercise Medicine, data has been collated from multiple UK based ERS to generate one of the largest databases of its kind and move towards meeting NICEs recommendation. Method: This paper describes the formation of The National Referral Database, its structure including outcome measures, data cleaning processes, and in two accompanying manuscripts the first initial observational insights are presented from analysis of this data. Results: Collating data from 19 ERSs on 24,086 individuals, a database has been created containing pre and post referral data for metrics including; physical activity, blood pressure, BMI, resting heart rate, SWEMWBS scores, ESES scores, WHO5 scores and ERQoL scores. After data cleaning processes there were 14 ERSs remaining covering 23,782 participants with an average age of 51±15 years and 68% of whom were female. Further, the database contains demographic information, reason for referral, medical conditions, and information on the referrer. Conclusion: This database has now been created and the initial data is available for researchers to interrogate. The National Referral Database represents a potentially valuable resource for the wider research community, as well as policy makers and practitioners in this area, which will facilitate a better understanding of ERS and other physical activity related social prescribing pathways to help inform public health policy and practice. Longer term plans include establishment of the database as an open resource, continually updated with additional data and version controls, for researchers to access for further research and policy makers and practitioners to use to inform their policies/practices.

This study evaluated the change in the concerns, wellbeing, and lifestyle behaviors of informal caregivers of people with cancer attending Penny Brohn UK's Living Well Course (LWC), a self-management education intervention.A pre-postcourse design collected self-reported quantitative and qualitative data from informal caregivers attending a LWC.Penny Brohn UK is a United Kingdom-based charity (not-for-profit) providing specialist integrative, whole person support, free of charge, to people affected by cancer.Informal caregivers taking part in a Penny Brohn UK LWC between June 2014 and May 2016 attending alongside the person with cancer.The LWC is a structured 15 h, multimodal group self-management educational course, designed to help people affected by cancer learn tools and techniques to help build resilience. Trained facilitators deliver LWCs to around 12 people with various types and stages of cancer and their informal caregivers.Measure Yourself Concern and Wellbeing (MYCaW) completed precourse and at 6 weeks postcourse; and bespoke 6-week follow-up Patient Reported Experience Measure.Four hundred eighty informal caregivers attended a LWC June 2014 to May 2016. One hundred eighteen completed a 6-week follow-up MYCaW: MYCaW Concerns 1 and 2 showed statistically significant improvements (p 0.0001), there was no significant improvement in wellbeing. Informal caregivers' most reported concerns relating to themselves were psychological and emotional issues (59%). The primary concern of the caregiver for the care recipient was related to the physical health of the person with cancer (40%). Eighty-seven percent of responding informal caregivers stated that the LWC enabled health self-management.The LWC was followed by an improvement in informal caregivers' concerns, and increased self-management of their own health needs. More studies, with larger sample size, are needed to explore if better self-management by informal caregivers may also lead to improvements in patients' health and wellbeing.

The term ‘whole person cancer care’ - an approach that addresses the needs of the person as well as treating the disease - is more widely understood in the UK than its synonym ‘integrative oncology”. The National Health Service (NHS), provides free access to care for all, which makes it harder to prioritise NHS funding of whole person medicine, where interventions may be multi-modal and lacking in cost-effectiveness data. Despite this, around 30% of cancer patients are known to use some form of complementary or alternative medicine (CAM). This is virtually never medically led, and usually without the support or even the knowledge of their oncology teams, with the exception of one or two large cancer centres. UK oncology services are, however, starting to be influenced from three sides; firstly, by well-developed and more holistic palliative care services; secondly, by directives from central government via the sustainable healthcare agenda; and thirdly, by increasing pressure from patient-led groups and cancer charities. CAM remains unlikely to be provided through the NHS, but nutrition, physical activity, mindfulness, and stress management are already becoming a core part of the NHS ‘Living With and Beyond Cancer’ agenda. This supports cancer survivors into stratified pathways of care, based on individual, self-reported holistic needs and risk assessments, which are shared between healthcare professionals and patients. Health and Wellbeing events are being built into cancer care pathways, designed to activate patients into self-management and support positive lifestyle change. Those with greater needs can be directed towards appropriate external providers, where many examples of innovative practice exist. These changes in policy and vision for the NHS present an opportunity for Integrative Oncology to develop further and to reach populations who would, in many other countries, remain underserved or hard-to-reach by whole person approaches.

Background - Social prescribing is a process whereby primary care patients are linked or referred to nonmedical sources of support in the community and voluntary sector. It is a concept that has arisen in practice and implemented widely in the United Kingdom and has been evaluated by various organizations.Objective - The aim of our study was to characterize, collate, and analyze the evidence from evaluation of social prescribing for type 2 diabetes in the United Kingdom and Ireland, comparing information available on publicly available websites with the published literature.Methods - We used a broad, pragmatic definition of social prescribing and conducted Web-based searches for websites of organizations providing potentially relevant services. We also explored linked information. In parallel, we searched Medline, PubMed, Cochrane Library, Google Scholar, and reference lists for relevant studies published in peer-reviewed journals. We extracted the data systematically on the characteristics, any reported evaluation, outcomes measured and results, and terminology used to describe each service.Results - We identified 40 UK- or Ireland-based projects that referred people with type 2 diabetes and prediabetes to nonmedical interventions or services provided in the community. We located evaluations of 24 projects; 11 as published papers, 12 as Web-based reports, and 1 as both a paper and a Web-based report. The interventions and services identified included structured group educational programs, exercise referral schemes, and individualized advice and support with signposting of health-related activities in the community. Although specific interventions such as community-based group educational programs and exercise referral have been evaluated in randomized controlled trials, evaluation of individualized social prescribing services involving people with type 2 diabetes has, in most cases, used pre-post and mixed methods approaches. These evaluations report generic improvement in a broad range of outcomes and provide an insight into the criteria for the success of social prescribing services.Conclusions - Our study revealed the varied models of social prescribing and nonmedical, community-based services available to people with type 2 diabetes and the extent of evaluation of these, which would not have been achieved by searching databases alone. The findings of this scoping study do not prove that social prescribing is an effective measure for people with type 2 diabetes in the United Kingdom, but can be used to inform future evaluation and contribute to the development of the evidence base for social prescribing. Accessing Web-based information provides a potential method for investigating how specific innovative health concepts, such as social prescribing, have been translated, implemented, and evaluated in practice. Several challenges were encountered including defining the concept, focusing on process plus intervention, and searching diverse, evolving Web-based sources. Further exploration of this approach will inform future research on the application of innovative health care concepts into practice.

Objective. Measure Yourself Concerns and Wellbeing (MYCaW) is a patient-centered questionnaire that allows cancer patients to identify and quantify the severity of their “concerns” and “wellbeing,” as opposed to using a predetermined list. MYCaW administration is brief and aids in prioritizing treatment approaches. Our goal was to assess the convergent validity and responsiveness of MYCaW scores over time, the generalizability of the existing qualitative coding framework in different complementary and integrative oncology settings and content validity. Methods. Baseline and 6-week follow-up data (n = 82) from MYCaW and FACIT-SpEx questionnaires were collected for a service evaluation of the Living Well with the Impact of Cancer course at Penny Brohn Cance Care. MYCaW convergent validity was determined using Spearman’s rank correlation test, and responsiveness indices assessed score changes over time. The existing qualitative coding framework was reviewed using a new data set (n = 158) and coverage of concern categories compared with items of existing outcome measures. Results. Good correlation between MYCaW and FACIT-SpEx score changes were achieved ( r = −0.57, P ≥ .01). MYCaW Profile and Concern scores were highly responsive to change: standardized response mean = 1.02 and 1.08; effect size = 1.26 and 1.22. MYCaW change scores showed the anticipated gradient of change according to clinically relevant degrees of change. Categories, including “spirituality,” “weight change,” and “practical concerns” were added to the coding framework to improve generalizability. Conclusions. MYCaW scores were highly responsive to change, allowing personalized patient outcomes to be quantified; the qualitative coding framework appears generalizable across different integrative oncology settings and has broader coverage of patient-identified concerns compared with existing cancer-related patient-reported outcome measures.

Psychometric properties of the QuickPIPERa shortened version of the PIPER Fatigue scale: This paper proposes 'QuickPIPER', a 15-item, validated one-dimensional model representing cancer-related fatigue, based on factor analysis testing of the Piper Fatigue Scale-revised (R-PFS). One hundred and eleven breast cancer survivors participated in this prospective, observational study of the QuickPIPER validation. Participants completed the R-PFS and the Profile of Mood States (POMS) Fatigue and Vigor subscales. The questionnaires were tested concurrently before and after a multimodal exercise programme trial. Psychometric characteristics assessed from the sample included internal consistency and factor analysis, concurrent criterion validity and predictive ability. The results shows that the correlation matrix for the QuickPIPER questionnaire was determined as suitable with the Kaiser-Meyer-Oklin values (0.89) and Bartlett's Test of Sphericity (P < 0.001). The total cumulative variance explained was 65.32%. The goodness-of-fit indices of confirmatory factor analysis were satisfactory (normed fit index = 0.91 and comparative fit index = 0.92). Test-retest reliability was very good (r = 0.947, P < 0.001). The QuickPIPER scores correlated with POMS Fatigue (r = 0.800) and POMS Vigor (r = -0.352) subscales. Predictive ability showed that the area under the curves for the screening questionnaires was 0.743 (95% confidence interval 0.579-0.906). The 15-item QuickPIPER possesses similar properties to the 22-item R-PFS and offers the important advantage of brevity. © 2013 Blackwell Publishing Ltd.

Social prescribing is a term used with increasing frequency to describe the process of enabling healthcare professionals to refer patients to a link worker, to co-design a non-clinical social prescription to improve their health and wellbeing.1 Original descriptions of social prescribing involved three components to a scheme: a referral from a healthcare professional, a consultation with a link worker and an agreed referral into the third sector.2–4 Social prescribing has developed to incorporate referrals into the arts, the natural environment, reading on prescription schemes and schemes to support health behaviour changes especially for long-term conditions. Other social prescribing schemes work to develop community cohesion such as time-banking, or address the social determinants of health by providing support for welfare, debt advice, housing and employment. In recent years, social prescribing has emerged as a strategy for tackling health inequities through partnerships between primary care and third sector organisations, and augmenting standard health and social care services. In practice, social prescribing provides an architecture to allow a person to move between professional sectors into their community; this was recently recognised in the General Practice Forward View which listed social prescribing as one of the 10 high-impact actions.5 Social prescribing is, therefore, able to address physiological, physical, psychological, psychosocial or socioeconomic issues, as well as enhancing community wellbeing and social inclusion.

Background: Auricular acupuncture has been identified as a possible method for modulating appetite and suggested as a cost-effective adjunct to current treatments for obesity. Objective: To investigate changes in reported feelings of hunger and satiety after auricular acupuncture. Design and Patients: Randomized, controlled, pilot study of 40 participants randomized to fasted control and intervention groups (n = 20 per group). Intervention: A 5-point (Hypothalamus, Hunger, Stomach, Point Zero, and Shenmen) unilateral auricular acupuncture procedure was applied to the intervention group, with needles left in place for 15 minutes. Control participants received equal time but no active intervention. Main Outcome Measures: Self-reported feelings of hunger and satiety using a hunger visual analog scale (VAS). Results: At 30 minutes following treatment, differences were observed on 3/5 of the questions in the hunger VAS. Compared with controls, the test group showed a decrease in appetite although it d...

Drawing on data from legal documents from 127 cases of men arrested for public sexual activity in known cruising locations (‘‘erotic oases’’), this article discusses the legal issue of selective prosecution. As shown, the decoy sting operations used to apprehend men engaging in same-sex sexual activities in public parks carry with them legal ramifications far beyond simply arresting and prosecuting offenders. A focus on the issues of discriminatory purpose and discriminatory effect is provided and discussion shows how each component of selective prosecution claims can (and did) influence the legal challenges of arrests of men engaging in same-sex sexual conduct in erotic oases.

The goal of this study is the determination of key themes to aid the analysis of qualitative data collected at three cancer support centres in England, using the Measure Yourself Concerns and Wellbeing (MYCaW) questionnaire. People with cancer who use complementary therapies experience and value a wide range of treatment effects, yet tools are urgently required to quantitatively measure these outcomes. MYCaW is an individualised questionnaire used in cancer support centres providing complementary therapies, scoring ‘concerns or problems’ and ‘well-being’ and collecting qualitative data about other major events in a patient’s life and what has been most important to the patient. Content analysis on 782 MYCaW questionnaires from people at these cancer support centres was carried out. The ‘concerns,’ ‘other things going on in their life’ and ‘important aspects of centre’ were thematically categorised and externally validated by a focus group, and the inter-rater reliability was calculated. Clinical information from a cancer patient’s perspective was collected that is not measured on standard quality-of-life questionnaires; furthermore, some themes acknowledge the multi-faceted aspects of complementary and alternative medicine provision, rather than information only relating to the therapeutic intervention. Categories for qualitative MYCaW analysis have been established providing a tool for future research and/or service delivery improvement within cancer support centres such as these. The established themes provide a framework to aid analysis of qualitative aspects of complementary therapy care for people with cancer, improving our understanding of how the patient’s cancer experience can be aided by complementary therapies in specialised cancer centres.

Scholarly investigations of men's same-sex anonymous sexual encounters have traditionally focused on identifying such behaviors as deviant and/or dangers to public health. Scholars have examined the structure and processes of such interactions, and typically presented the cruising process as one characterized by silence and a reliance on non-verbal communications. Drawing on law enforcement and court documents pertaining to a sample of 127 cases of men arrested for cruising activities, this study highlights the role that verbal exchanges and conversation play in such endeavors. Findings reveal that silence is not a contextual norm and conversation serves multiple purposes in the activities of men seeking men for anonymous, public-location sexual activities.

Background Supported self-management, acupuncture and information can help reduce the symptoms of low back pain. These approaches are currently recommended by NICE guidance as treatment options for patients with persistent low back pain. However, there has been no previous evaluation of a service providing them together for this common problem. The purpose of this service evaluation was to report patient outcomes and experiences of the Beating Back Pain Service (BBPS), a pilot service based in a primary and community care setting, delivering acupuncture, self-management and information to patients with chronic low back pain. Methods Patients completed a questionnaire at three time points: pre-BBPS, immediately post-BBPS and three months post-BBPS. Outcome measures included the Bournemouth Questionnaire (measuring musculoskeletal, MSK, problems), EuroQoL-5D (measuring quality of life), Pain and Self-efficacy Questionnaire, and additional questions on medication use, physical activity, understanding of pain and positive well-being. Additionally, the STarT Back (measuring risk of developing chronic pain) was collected at BBPS information sessions. Non-parametric tests were used to evaluate pre- and post- variables. Questionnaires also collected qualitative data (open-text responses) regarding patient views and experiences of the BBPS, which were analysed using thematic analysis. Results 80 (out of 108) patients who attended the initial BBPS information session agreed to participate in the service evaluation (mean age 47 years, 65% female). 65 patients attended subsequent BBPS acupuncture and/or self-management sessions and were asked to complete post-treatment questionnaires; complete datasets were available for 61 patients. There were statistically significant improvements over time for pain (p

Endometriosis is an enigmatic disease characterized by the presence and growth of endometrial-like tissue outside the uterine cavity. The etiology of endometriosis is poorly understood, yet recent evidence suggests that epigenetic aberrations and heritable changes in the genome may be the key to understanding how to approach this disease. Difficulty in long-term management of endometriosis symptoms and unpredictability of treatment outcome necessitate research into other treatment modalities, such as Western herbal medicine. This article reviews commonly used herbs in the treatment of endometriosis, the effects of phytochemical constituents on endometrial cells, and the impact on the epigenome.

Patient experience of acupuncture at a GP surgery was evaluated over 18 months. Patients were referred for six acupuncture treatments of 45 min by 10 practising GPs. Measure Your Medical Outcome Profile (MYMOP), was completed before the first treatment and at the start of the final consultation. A patient experience survey was completed immediately after the patient's last appointment. Results A statistically and clinically significant improvement in the mean MYMOP profile score (1.6 SD 1.3, p n = 47); reduction in medication usage; a reduction in pain and stress and improved quality of life. Conclusions Acupuncture provision was beneficial to patients with predominately chronic conditions. Further studies are needed to assess the cost effectiveness and long term benefit of acupuncture in the NHS.

This study aimed to investigate the immediate effects of the secretory immunoglobulin A (sIgA), α-amylase activity and blood pressure levels after the application of a Reiki session in nurses with Burnout Syndrome. A randomized, double-blind, placebo-controlled, crossover design was conducted to compare the immediate effects of Reiki versus control intervention (Hand-off sham intervention) in nurses with Burnout Syndrome. Sample was composed of eighteen nurses (aged 34-56 years) with burnout syndrome. Participants were randomly assigned to receive either a Reiki treatment or a placebo (sham Reiki) treatment, according to the established order in two different days. The ANOVA showed a significant interaction time x intervention for diastolic blood pressure (F=4.92, P=0.04) and sIgA concentration (F=4.71, P=0.04). A Reiki session can produce an immediate and statistically significant improvement in sIgA concentration and diastolic blood pressure in nurses with Burnout Syndrome. O objetivo deste estudo foi investigar os efeitos imediatos na imunoglobulina A salivar (IgAs), na atividade de α-amilase e na pressão arterial, após uma aplicação de Reiki em enfermeiras que sofrem da síndrome de Burnout. Foi realizado ensaio clínico randomizado duplo-cego e placebo controlado, com desenho cruzado. Dezoito enfermeiras (idade entre 34 e 56 anos), com síndrome de Burnout, participaram do estudo. As participantes receberam tratamento com Reiki ou Reiki falso, de acordo com a ordem estabelecida, através da randomização em dois dias distintos. O teste de Anova mostrou interação significativa entre o momento da intervenção e a pressão arterial diastólica (F=4,92, p=0,04) e os níveis de sIgA (F=4,71, p=0,04). Conclui-se que uma sessão de Reiki de 30 minutos pode melhorar de forma imediata a resposta de IgAs e da pressão arterial diastólica em enfermeiras com síndrome de Burnout. El objetivo fue investigar los efectos inmediatos en inmunoglobulina A salival (IgAs), actividad de α-amilasa y presión arterial de una aplicación de reiki en enfermeras sufriendo síndrome de Burnout. Se utilizó un ensayo preliminar placebo randomizado con cegamiento doble utilizando un diseño cruzado. Dieciocho enfermeras (edad 34-56) con síndrome de Burnout participaron en el estudio. Las participantes recibieron tratamiento con Reiki o Reiki fingido según el orden establecido por la randomización en dos días distintos. El test de ANOVA mostró un interacción significativa momento intervención para la presión arterial diastólica (F=4.92, P=0.04) a y la concentración de sIgA (F=4.71, P=0.04). Una sesión de Reiki de 30 minutos puede mejorar de manera inmediata la respuesta de IgAs y la presión arterial diastólica en enfermeras con síndrome de Burnout.

Introduction - Nutritional therapy (NT) is a bioscience-based branch of complementary and alternative medicine (CAM) with National Occupational Standards (NOS) and accredited training courses which include compulsory clinical training. Approximately 900 practitioners are registered with the voluntary regulator, the Complementary and Natural Healthcare Council (CNHC), but the number of unregulated practitioners is unknown. Cancer is a leading cause of death worldwide; nutrition and lifestyle factors may affect recurrence and survival rates. Many cancer patients and survivors seek individualised advice on diet and use of supplements and appropriately skilled nutritional therapy practitioners (NTP) may be well-placed to safely provide this advice. Little is known of NTPs’ perspectives on working with people affected by cancer; this study seeks to explore their views on training, use of evidence and other resources, to support the development of safe evidence-based practice in this important clinical area. Methods – An on-line anonymised questionnaire collected data from participants recruited from all UK registered NTPs. Recruitment was facilitated by the British Association for Applied Nutrition and Nutritional Therapy (BANT). Quantitative data on practitioner characteristics, years in practice, other therapies practiced and work with cancer clients were collected. Qualitative data on types of evidence used, barriers to practice and perceived training and support needs when working with clients with cancer, were collected and analysed. SPSS was used to produce descriptive statistics. Preliminary Results – 274/888 (31%) of registered NTPs participated. 61% respondents had accredited NT qualifications of which 46% were at degree or post-graduate level. 73% (202) participants indicated they also had other higher education qualifications, including 153 (56%) at degree or above. When asked to describe their position on cancer work, 17% respondents (40/238) indicated no interest, and 35% (84/238) respondents already work with cancer clients (cancer practitioners - CP). A further 48% (114/238) respondents expressed interest in starting cancer work, and typically requested specialist training and practice guidelines to support this area of clinical practice. Cancer practitioners (CP) rated searches of peer-reviewed literature as most useful for information to support practice, whereas commercial product information was rated least useful. CPs requested engagement with mainstream medicine, more access to research evidence and professional recognition to facilitate and support work with cancer clients. A need for professional networking, mentorship and/or supervision was noted by CP and non-CP respondents, which is of interest since 81% all participants worked as sole practitioners exclusively or as part of their practice

Chronic pain (CP) and rheumatoid arthritis (RA) pose particular challenges for the individual. Although biomedicine inevitably plays a role in the reduction or control of some symptoms for people living with chronic pain, directed self-management is also increasingly recognized as an important tool. Self-management can address pain-associated symptoms of CP and RA, and often has broader aims, such as promoting positive well-being. Forty-six interviews with people experiencing CP and 46 interviews with those living with RA-associated pain were analyzed. Our analysis uncovered three broad strategies adopted by participants: body management, mind-management and mindbody management. The analysis demonstrated that for those living with pain, a sense of well-being is achieved not through pain control alone, but also through various mind/body techniques for managing pain, accepting new limits, and adjusting the way people relate to themselves. These self-management strategies are an important adjunct to biomedical care for those experiencing chronic pain.

The widespread use of complementary therapies alongside biomedical treatment by people with cancer is not supported by evidence from clinical trials. We aimed to use combined qualitative and quantitative data to describe and measure individualised experiences and outcomes.In three integrative cancer support centres (two breast cancer only) in the UK, consecutive patients completed the individualised outcome questionnaire Measure Yourself Concerns and Wellbeing (MYCaW) before and after treatment. MYCaW collects quantitative data (seven-point scales) and written qualitative data and the qualitative data were analysed using published categories.Seven hundred eighty-two participants, 92% female, mean age 51 years, nominated a wide range of concerns. Psychological and emotional concerns predominated. At follow-up, the mean change (improvement) in scores (n = 588) were: concern 1, 2.06 (95% CI 1.92-2.20); concern 2, 1.74 (95% CI 1.60-1.90); and well-being, 0.64 (95% CI 0.52-0.75). The most common responses to 'what has been the most important aspect for you?' were 'receiving complementary therapies on an individual or group basis' (26.2%); 'support and understanding received from therapists' (17.1%) and 'time spent with other patients at the centres' (16.1%). Positive (61.5%) and negative (38.5%) descriptions of 'other things affecting your health' correlated with larger and smaller improvement in concerns and well-being, respectively.In a multicentre evaluation, the MYCaW questionnaire provides rich data about patient experience, changes over time and perceptions of what was important to each individual with cancer within that experience. It is unlikely that meaningful evaluations of this complex intervention could be carried out by quantitative methods alone.

Conclusion: 1. A variety of concerns faced by supporters/carers in their experience are both positive and negative. 2. Change can occur on an emotional, psychological, physical, biochemical and spiritual level, as soon as the person with cancer is diagnosed. 3. The supporter experience is complex yet interconnected, affecting different dimensions of a person’s lifestyle and their identity. 4. Interventions that ‘support the supporter’ help them to gain a sense of control, the ability to cope and minimise the negative impact of the supporter role. 5. These data are being used to develop an analysis framework for MYCaW and supporters. References

Introduction: Cancer is a leading cause of death worldwide. Nutrition may affect occurrence, recurrence and survival rates and many cancer patients and survivors seek individualized nutrition advice. Appropriately skilled nutritional therapy (NT) practitioners may be well-placed to safely provide this advice, but little is known of their perspectives on working with people affected by cancer. This mixed-methods study seeks to explore their views on training, barriers to practice, use of evidence, and other resources, to support the development of safe evidence-based practice. Preliminary data on barriers to practice are reported here. Methods: Two cohorts of NT practitioners were recruited from all UK registered NT practitioners, by an on-line anonymous survey. 84 cancer practitioners (CP) and 165 non-cancer practitioners (NCP) were recruited. Mixed quantitative and qualitative data was collected by the survey. Content analysis was used to analyze qualitative data on the use of evidence, barriers to practice and perceived needs for working with clients with cancer, for further exploration using interviews and focus groups. Preliminary results: For the NCP cohort, exploring themes of perceived barriers to working with people affected by cancer suggested that perceived complexity, risk and need for caution in this area of practice were important barriers. Insufficient specialist knowledge and skills also emerged as barriers. Some NCPs perceived opposition from medical practitioners and other mainstream healthcare professions as an obstacle to starting cancer practice. To overcome these barriers, specialist training emerged as most important. For the CP cohort, in exploring the skills they considered enabled them to undertake cancer work, specialist clinical and technical knowledge emerged strongly. Only 10% CP participants did not want more work with people affected by cancer. 10% CPs reported some NHS referrals, whereas most received clients by self-referral or from other practitioners. When considering barriers that impede their cancer practice, the dominant categories for CPs were hostility or opposition by mainstream oncology professionals, and lack of dialogue and engagement with them. To overcome these barriers, CPs desired engagement with oncology professionals and recognized specialist cancer NT training. For both NCPs and CPs, evidence resources, practice guidelines and practitioner support networks also emerged as potential enablers to cancer practice. Conclusions: This is the first detailed exploration of NT practitioners’ perceived barriers to working with people affected by cancer. Acquiring specialist skills and knowledge appears important to enable NCPs to start cancer work, and for CPs with these skills, the perceived barriers appear foremost in the relationship with mainstream cancer professionals. Further exploration of these themes, and other NT practitioner perspectives on working with people affected by cancer, is underway. This work will inform and support the development of professional practice, training and other resources.

BACKGROUND Global deaths from cancer are currently in excess of 6.7million. Cancer has come to be perceived as a tentative ongoing life event with unpredictable and/or unforeseeable health-related outcomes and associated psychosocial concerns/burdens. The expression ‘cancer survivor’ has been interpreted by researchers and healthcare providers as a framework to understand the impact of the dynamic nature of the cancer experience, namely; the physical, psychological, existential and social impact on an individual’s life

Background Spinal manipulation and acupuncture can be helpful in reducing the symptoms of musculoskeletal (MSK) pain. Both approaches are currently recommended by NICE as treatment options for patients with persistent low back pain. However, there has been no previous evaluation of a GP service using them together for MSK pain. The purpose of this study was to evaluate acceptability and outcomes for an osteopathy and acupuncture service (delivered by complementary therapy practitioners) for patients with MSK problems provided within a General Practice. Methods Patients were asked to complete a questionnaire before and after their course of treatment. Outcome measures included the Bournemouth Questionnaire (measuring MSK problems), EuroQoL-5D (measuring quality of life), medication use, physical activity and general well-being. Non-parametric tests were used to compare pre- and post- treatment variables. Qualitative data, regarding participants' views on the service, were collected from patients via a service survey and healthcare professionals via interviews. Qualitative data were analysed using thematic analysis. Results 123 adults with MSK problems were referred into the service (79 female and 44 male, mean age 49 years). Complete patient questionnaire data sets (pre- and post- treatment) were available for 102 participants; 91 completed a service survey. All healthcare professionals involved in the service participated in interviews including all seven GPs and the administration manager at the practice, as well as the three acupuncture/osteopathy practitioners. Patient outcomes: comparisons between pre and post-treatment revealed a statistically significant improvement in MSK pain (p < 0.0001) and quality of life (p < 0.0001), and a statistically significant reduction in medication use (p < 0.0001). Qualitative analysis found that patients reported improvements in their MSK pain, mobility, other physical health conditions, well-being and self-management of their MSK problem. Acceptability of the service: overall patients and healthcare professionals were satisfied with the service and its provision within the Practice. Patients reported wanting increased appointment availability and flexibility, and more sessions. Complementary therapy practitioners reported finding the high number of referrals of chronic patients challenging, and wanting increased communication with GPs. Conclusions Provision of acupuncture and osteopathy for MSK pain is achievable in General Practice. A GP surgery can quickly adapt to incorporate complementary therapy provided key principles are followed.