This study showed that state laws and policies constrain the locational preferences of alternative health care providers to varying degrees, depending on the particular profession and level of legal status. Three separate surveys were conducted, focusing on acupuncturists, chiropractors and homeopaths in Maryland, Virginia, North Carolina, and the District of Columbia. The acupuncture findings revealed intraprofessional divisions that lead to a strong influence of legal constraints on the locational behavior of non-MD acupuncturists. Results from the chiropractic survey reflected an established profession with a less pronounced, but moderate, influence of state laws and policies on location and mobility. The homeopathy findings, while based on a much smaller sample, did not reveal a strong relationship between legal constraints and spatial characteristics, except in the extreme case of North Carolina's recent prohibition. This study also postulated a model to explain the progression of alternative health care professions toward legitimation. The variables of public acceptance and legal constraints on location were plotted on the model to identify particular levels of progression. The importance of this research is highlighted by impending health care reforms, the need for access to professional health services, skyrocketing biomedical costs, and the documented utilization of alternative health care in this country. / Master of Science

The aim of the study was to determine the extent of the psychological influence that human cadaver dissection has on Homoeopathy and Chiropractic students. Changes in axiety levels, appraisals (of the self, the situation and the environment), coping strategies and behavioural changes were investigated during the following four dissection phases: (i) before the dissection started (preparation); (ii) the first dissection period (exposure); (iii) two weeks after dissection started (development of resources) and (iv) three months after dissection started (stabilisation). Anxiety levels were measured using the Taylor Manifest Anxiety Scale and the Templer Death Anxiety Scale. The remaining sections of the self-administered questionnaire included open and closed ended sections. Anxiety levels were found to be low, possibly due to students being previously exposure to the dissection hall, during peer tutoring sessions. Although active coping strategies were used most often, no clear pattern emerged with regard to which coping strategy was more effective in dealing with dissection anxiety. / Psychology / M. Sc. (Psychology)

The aim of the study was to determine the extent of the psychological influence that human cadaver dissection has on Homoeopathy and Chiropractic students. Changes in axiety levels, appraisals (of the self, the situation and the environment), coping strategies and behavioural changes were investigated during the following four dissection phases: (i) before the dissection started (preparation); (ii) the first dissection period (exposure); (iii) two weeks after dissection started (development of resources) and (iv) three months after dissection started (stabilisation). Anxiety levels were measured using the Taylor Manifest Anxiety Scale and the Templer Death Anxiety Scale. The remaining sections of the self-administered questionnaire included open and closed ended sections. Anxiety levels were found to be low, possibly due to students being previously exposure to the dissection hall, during peer tutoring sessions. Although active coping strategies were used most often, no clear pattern emerged with regard to which coping strategy was more effective in dealing with dissection anxiety. / Psychology / M. Sc. (Psychology)

Contexte : Les enfants atteints de maladies chroniques utilisent souvent des médecines complémentaires. Plusieurs études traitent de l’utilisation de ces traitements et des facteurs qui y sont associés chez les enfants atteints d’arthrite juvénile mais aucune étude n’est longitudinale. De plus, aucune n’a documenté l’utilisation de ces traitements chez les enfants ayant des incapacités physiques en attente de services publics de réadaptation. Objectifs : Les objectifs de cette étude étaient de déterminer la fréquence d’utilisation des médecines complémentaires chez les enfants atteints d’arthrite juvénile et d’incapacités physiques, d’évaluer leur efficacité telle que perçue par les parents et d’explorer les facteurs associés à leur utilisation. Méthodes : Une cohorte d’enfants atteints d’arthrite juvénile idiopathique (n=182, âge moyen : 10,2 ans) qui fréquentent des cliniques d’arthrite et une cohorte d’enfants ayant des incapacités physiques en attente de services de réadaptation publics (n=224, âge moyen : 2,6 ans) ont été suivis durant une période d’un an. L’utilisation des médecines complémentaires et la perception de leur efficacité d’après les parents ont été évaluées à l’aide de statistiques descriptives à chaque trois mois pour la cohorte d’enfants atteints d’arthrite et au début de l’étude pour la cohorte d’enfants ayant des incapacités physiques. Les facteurs associés à l’utilisation de ces traitements ont été explorés par des analyses de type GEE (« Generalized estimating equations ») et des régressions polytomique et logistique. Résultats : L’utilisation antérieure de ces médecines était de 51,1% pour les enfants atteints d’arthrite et de 15% pour les enfants ayant des incapacités physiques. Les médecines complémentaires étaient considérées comme étant efficaces dans 72% des cas par les parents d’enfants atteints d’arthrite et dans 83% des cas par les parents d’enfants ayant des incapacités physiques. Les facteurs associés à l’utilisation des médecines complémentaires chez les enfants atteints d’arthrite étaient l’utilisation antérieure des médecines complémentaires par les parents et la perception des parents que les médicaments prescrits ne sont pas utiles pour leur enfant. Chez les enfants ayant des incapacités physiques, les facteurs associés à l’utilisation des médecines complémentaires étaient l’origine culturelle canadienne, un niveau de scolarité plus élevé que le diplôme d’études secondaires et une moins bonne qualité de vie reliée à la santé. Finalement, l’utilisation des médecines complémentaires semblait associée à de moins bons résultats chez les enfants atteints d’arthrite. Conclusion: Une proportion non-négligeable des enfants participant à la présente étude ont utilisé des médecines complémentaires. Leur utilisation était plus fréquente chez les enfants atteints d’arthrite juvénile idiopathique, surtout chez ceux dont les parents avaient déjà utilisé les médecines complémentaires par le passé et chez ceux qui trouvaient la médication peu efficace. Chez les enfants ayant des incapacités physiques, l’utilisation des médecines complémentaires était associée à des facteurs socio-démographiques et à des besoins plus élevés en matière de santé. Les médecines complémentaires étaient considérées comme étant efficaces dans les deux cohortes mais leur utilisation était associée à de faibles résultats chez les enfants atteints d’arthrite. Ces résultats démontrent l’importance d’évaluer l’utilisation des médecines complémentaires afin de mieux renseigner les parents et de les aider à prendre les meilleures décisions possibles concernant le traitement de leur enfant. / Background: Children with chronic diseases often use complementary and alternative health care (CAHC). Several studies described the use of these treatments and the factors associated with it. However, no longitudinal studies were conducted to determine the use of these treatments over time. Furthermore, no study has evaluated CAHC use in children who were waiting for public rehabilitation services. Objective: The aim was to determine the frequency of CAHC use in children with juvenile idiopathic arthritis (JIA) and children with various physical disabilities (PD), to evaluate its effectiveness from the parents’ points of view and to explore the factors associated with their utilization. Methods: A cohort of children with JIA (n=182, mean age: 10.2 years) who attended arthritis clinics and a cohort of children with physical disabilities (n=224, mean age: 2.6 years) waiting for public rehabilitation services were followed for one year. We evaluated the use of CAHC and its effectiveness from the parents’ points of view at three month intervals for children with JIA and at the beginning of the study for children with PD, using descriptive statistics. We explored factors associated with their utilization, using GEE (“Generalized estimating equations »), polytomous and logistic regression. Results : Previous use of CAHC was 51.1% for children with JIA and 15% for children with PD. CAHC was considered beneficial in 72% of the cases by parents of children with JIA and in 83% of the cases by parents of children with PD. Factors associated with higher use of CAHC in children with JIA were previous use of CAHC by parents and lower perceived helpfulness of prescribed medications (p<0.05). In children with PD, factors associated with higher use of CAHC were Canadian cultural background, mother’s level of education higher than high school and lower health-related quality of life. Finally, in children with JIA, CAHC use was associated with worse outcomes. Conclusions: Many children in our study used CAHC. Its use was more common in children with JIA, particularly among those whose parents used it previously and found medications to be less helpful. For children with PD, use of CAHC was associated with socio-demographic factors as well as higher children’s health needs. CAHC were perceived to be beneficial in both cohorts but its use was associated with worse outcomes for children with JIA. This underlines the importance for health professionals to evaluate CAHC use in order to better inform parents, which may help them make the best decisions regarding their child’s treatment.

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