South Africa hosts a plural healthcare system that includes an allopathic sector and a complementary and alternative healthcare sector. This research report seeks to understand the motivations behind why people use the complementary system of Ayurveda, in South Africa and how they decide on its use through processes governing their decision making methods. The literature review summarises the key theoretical framework which moulded the study. The themes incorporated in the review include medicine’s evolution, Ayurveda, medical pluralism and complementary and alternative medicine, the illness experience and help seeking behaviour, the sick role and its relation to help seeking behaviour, and the Health Belief Model. The research was qualitative in nature and entailed semi structured interviews that were conducted with twenty seven Ayurveda users and three Ayurvedic doctors. The findings and analysis draw on the literature review, and when analysed, are developed into three coherent themes namely Ayurveda in South Africa (sets the scene of Ayurveda within the country), Reasons for using Ayurveda (the motivations behind people’s help seeking behaviours toward the system), and the use of Ayurveda in relation to other healing systems. The research found that Ayurveda is currently undergoing resurgence in South African society and in the process links itself to the wider global context that Ayurveda has situated itself. We also discover that participant’s decisions on the use of Ayurveda were decided upon through a multitude of factors and often Ayurveda was also utilised in many different situations rather than for a single case. Such interconnecting factors include their socialisation, lay referrals, interest in alternative systems, a sense of Indian pride and a cynical perception of Western medicine. Alternative or complementary system use was decided upon through factors that linked to people’s access of the alternative services and its affordability. Decisions ultimately were made to use Ayurveda as a complementary system to allopathy. Finally the conclusions of the study indicate that Ayurveda was transferred to South Africa, from India, through the country’s system of indentured labour where knowledge of the practice was passed down along generations. The research also deduces that it is primarily the Indian race that uses Ayurveda in South Africa and as such the healing system is more prominent in Indian areas. In addition, Ayurveda was not found to be a viable health or healing option for the wider South African population for whom its affordability and accessibility pose barriers.

Inom dagens hälso- och sjukvård finns det metoder som kompletterar den västerländska skolmedicinen. Metoder som kan komma att användas när skolmedicinen inte räcker till. Genomgående för vården med Komplementär och alternativ medicin, KAM metoder är en prägling av helhetstänkande ibland även kallat holistiskt synsätt.Syftet med denna uppsats är att beskriva den befintliga forskningslitteraturen med avseende på sjuksköterskans och övriga vårdpersonalens uppfattningar om KAM samt hur KAM används inom vården.Åtta studier sammanställdes och analyserades i en litteraturöversikt för att få en överblick över kunskapsläget. Resultatet presenteras med två huvudkategorier. Kategorierna är Uppfattning om KAM och Hur KAM används i vården. Uppfattning om KAM påverkas av önskan om mer kunskap om KAM, oklar definition av KAM, varierande personligt förhållningssätt till KAM och bristande evidens hos KAM. Hur KAM används i vården påverkas av hur sjuksköterskorna och övrig vårdpersonal uppfattar det att tala med patienter om KAM samt att makt- och organisationsstrukturer är ett hinder på arbetsplatsen. I diskussionen behandlas underkategorierna att tala med patient om KAM, där det diskuteras om hur sjuksköterskorna och övrig vårdpersonal talade om KAM med patienter trots att de kände sig obekväma, sjuksköterskor och övriga vårdpersonals önskan om ökad kunskap samt makt- och organisationsstrukturer som hinder för KAM inom hälso- och sjukvården. / Program: Sjuksköterskeutbildning

Title: Possibilities of Usage of the Electrotherapy Currents in Electropuncture. Defining the problem: Elektropuncture is a therapeutic method that uses electric current to the stimulation of acupuncture points or projections on the surface of the body. Because it is an alternative method of treatment, some specialists as well as nonprofessionals don't acknowledge the electropuncture as an effective method of treatment. My thesis is focused on issues elektropuncture approach and on evaluation of its therapeutic effectiveness and usefulness in the field of physical therapy by using low- frequency currents. Objectives of work: The aim is to bring the issue of the use of low-frequency currents in elektropuncture and to describe in detail the currents, which can be used, to evaluate and to process the resources available in the literature to find a scientific evidence of its therapeutic effectiveness and use elektropuncture in physiotherapy. Method of solution: In my thesis, there will be processed all available sources of information about the electroacupuncture, elektropuncture, acupuncture and alternative medicine, physiotherapy, electrotherapy, low-frequency currents. I draw upon the English, Czech, Slovak and German publications. No particular publication will be an earlier release than the 1980th...

Integrative medicine (IM) has organized as a new area of specialization in mainstream healthcare. The development of IM is widely attributed to popular demand for the range of therapies known collectively as Complementary and Alternative Medicine (CAM). During the 1990's the rate of acceptance of CAM accelerated among consumers, professions, financing and education. The Medical Expenditure Panel Survey (MEPS) measured CAM utilization and professional service provision during the years 1996 and 1998, but never since. These surveys were unique because they specifically inquired as to whether CAM was provided by a physician, among other types of professionals. This dissertation defines early integrative medicine (MDCAM) as CAM therapies provided by physicians. Because the MDCAM subpopulation is small, MEPS surveys for 1996 and 1998 were combined (N=39,314) to improve statistical power. The theoretical approach employed Abbott's (1988) theory of a system of professions, in which MDCAM represents a professional strategy of client differentiation through the social boundary mechanism of borrowing (Tilly, 2004) specific CAM therapies to satisfy consumer demand. The utility of the theory of a system of professions is discussed for its ability to decouple conceptual-level claims from observable workplace-level behaviors. Nearly one million Americans received CAM therapies from their physicians during the period, and this professional behavior was found in every region of the country. Services provided by physicians included spiritual healing, massage and acupuncture; national population prevalence estimates are provided. This is meaningful because physicians, at the time, were at risk for disciplinary action for providing CAM. The MDCAM subpopulation was similar to those who used both conventional and CAM services from other professional sources (BOTH), however, MDCAM reported much higher prescription medication use. The demographic profile of MDCAM was more similar to those who consume health care services frequently, compared to infrequent consumers. The MDCAM group is distinguished from those who use BOTH by increased utilization of the following services: nutritional advice, biofeedback and meditation. MDCAM is characterized by diagnoses of chronic illness. MDCAM recipients used mainstream medicine, yet employed disease management services offered by the CAM domain.

The use of complementary and alternative medicine (CAM) among U.S. college students and the general public is substantial and growing; however, research on the characteristics of college students who use CAM and the factors that influence their decision to use CAM is scarce. The present study applied the sociobehavioral model of healthcare utilization to the examination of CAM utilization in a sample of college students in the western U.S. A total of 592 college students from ages 18-52 from two universities within the western U.S. completed a web-based survey assessing the relationships between their demographic characteristics, health locus of control beliefs, religious and spiritual beliefs, and physical and mental health status and their lifetime and past 12-month use of CAM across five domains (alternative medicine systems, biologically based therapies, manipulative and body based treatments, mind-body medicine, and energy medicine). Statistically significant relationships were found between CAM use and biological sex, financial dependency status, internal health locus of control, mental health status, and bodily pain. These predictors were combined, along with college attended, according to the sociobehavioral model of healthcare utilization and tested for their predictive efficacy. One hundred percent of those surveyed reported use of at least one type of CAM practice within their lifetime, and 88% reported use of at least one type of CAM practice within the last year. The interventions used most by college students in this study were deep breathing exercises (50.7%), yoga (39.7%), massage (37.8%), meditation (35.8%), pilates (20.4%), and chiropractic or osteopathic manipulation (20.1%). Moreover, they endorsed using these practices for the promotion of general wellness, improvement of psychological functioning, and alleviation of pain. Multiple linear regression analyses of these variables revealed that their combination explained from 4.0% to 17.6% of the variance in CAM use in this sample. Results indicated that this model can be successfully applied to CAM use. These findings were evaluated and compared with previous findings regarding CAM use in both general population and college student samples. Specific implications for the fields of psychology, medicine, and health education within the areas of practice and research are discussed.

Combining the use of alternative and complementary therapies and orthodox medicine is an increasing phenomenon. This thesis examines the implications of mixing and matching plural healing modalities against a backdrop of patient and practitioner responsibilities. From an anthropological perspective, the predominant use of qualitative methodology is an integral part of this research project. Central to this study is the views of a variety of participant categories - patients who use both alternative and orthodox healing methods; non-medical alternative and complementary practitioners; medical doctors who integrate orthodox and CAM therapies into their daily practise; and orthodox general practitioners. Interviews with these participants took place over an eighteen-month timeframe and involved face-to-face interviews, telephone interviews, and focus group research. Social constructionist theory, which forms part of the compendium of interpretive theoretical approaches adopted under the medical anthropology paradigm, has been used in order to expose the beliefs patients and practitioners hold about their own responsibilities, and those of the other participant categories. This study reveals a palimpsest of complex, contradictory and competing discourses in relation to patient and practitioner expectations and responsibilities. One important finding relates to the significance of neo-liberal and individualistic ideologies. This thesis concludes that the rhetoric from complementary and alternative practitioners, and their integrative colleagues, is heavily imbued with ideas about self-responsibility, particularly in relation to patient lifestyle choices and therapeutic compliance. Patients and orthodox general practitioners share some of these views but in general adopt a more collective approach to health care responsibilities. While patients are prepared to accept some responsibility for their illnesses and health keeping practises, they express strong reliance towards the orthodox health model as well as those doctors who practise integrative medicine. However the same cannot be said of their attitudes towards CAM modalities where considerable ambivalence is evident towards both practitioners and the therapies themselves. The role of the state, and its responsibilities for the structure of the health care system in New Zealand, is also clearly influential in the construction of belief systems. This is especially so because the rhetoric underlying neo-liberal and individualistic discourses now permeates the direction of health policies. Increasing levels of surveillance, both at bureaucratic and individual levels, also attests to the influence of neo-liberalism and individualism. This study exposes the tensions between the rhetoric of self-responsibility and the lived experiences of patients and health practitioners, which in many cases is more collective in its focus than is initially apparent.

The fundamental aim of any regulatory system for professional services should be the provision of quality professional services that serve the public interest. The public interest element is paramount to determine what services are regulated and how those services are regulated. This thesis suggests that the current regulatory structure is dominated by the public interest as defined by orthodox medicine (OM). This has skewed the regulatory structure against consumer choices that favour greater reliance upon complementary and alternative medicine (CAM). A postmodernist perspective suggests the need to revisit the current regulatory structure to embrace perspectives on health derived from individuality and personal empiricism free of the modernist outlook characteristic of OM.

The use of complementary and alternative medicines and therapies (CAM) in Australia and across the world is becoming increasingly prevalent. The most recent survey conducted by MacLennon et al. in 2004 [2] identified that more than half the general Australian population had used some form of CAM in the previous 12 months before the survey was conducted.[2-4] Up until now, the prevalence of CAM use among elite Australian athletes was unknown. As athletes are constantly looking to gain an advantage over their competitors through physical or psychological interventions or through the application of new technologies, it was hypothesised that the use of CAM in this group would be higher in athletes than in the general population. After surveying 497 elite Australian athletes we found that 93% of this specific population utilised at least one CAM within their lifetime. The 10 CAM (as defined by the Therapeutics Goods Administration) used most frequently were sports drinks, massage, sports bars, cereal bars, multivitamins, aloe vera, sports gels, Pilates, caffeine and yoga. There were no significant differences identified between specific sporting groups- football codes, court sports, field sports, water sports and others, with all groups reporting high usage. Sports physicians, family, coaches and friends were identified as the main sources for product information, with health food shops, sports dieticians and sports physicians being the predominant providers of the actual product. Four CAM sold on the Australian market which purported to decrease the symptoms of delayed onset muscle soreness (DOMS), or reported anti-inflammatory properties which could impact of the inflammatory response associated with DOMS were studied. Lyprinol® (an anti-inflammatory agent), topical Arnica (for symptomatic relief of soft tissue trauma), Tienchi Ginseng (proposed to relieve symptoms of DOMS) and Devil’s Claw (an analgesic and anti-inflammatory agent) were the chosen CAM. Four separate randomised, double blind placebo controlled studies comprising of 20 subjects per study were carried out with the same DOMS inducing methodology (downhill treadmill running) employed. All subjects in each of the four studies had their performance (counter movement and squat jump, maximal force), pain (visual analogue scale and muscle tenderness) and blood parameters (high sensitivity C-reactive protein, interleukin-1A, interleukin-6, tumour necrosis factor-K, creatine kinase and myoglobin) analysed seven times over five days. Lyprinol® did not affect performance, pain or blood markers of muscle damage and inflammation analysed in this study. Despite Lyprinol® being marketed as having “potent anti-inflammatory” properties, Lyprinol® did not demonstrate any antiinflammatory properties in our sample group at a dose of 200mg daily for two months, and did not alter any of the markers of inflammation after a downhill running protocol. A significant difference was identified in quadriceps muscle tenderness between the topical Arnica and placebo groups 72 hours after the downhill running protocol. This indicated that the topical Arnica group experienced less quadriceps pain at this time point, though this was not reflected in the quadriceps visual analogue scale results. There were significant differences identified between the topical Arnica and placebo groups for muscle tenderness in the gastrocnemius and tumour necrosis factor-K concentration at baseline. Further statistical analysis assessing relative changes from baseline did not demonstrate any statistically significant differences between the groups for either of these parameters. We therefore conclude that the symptomatic relief of soft tissue trauma claimed from a topical Arnica product sold in Australia was not conclusively demonstrated in this study. The single, isolated significant difference identified in quadriceps tenderness does not conclusively, from this study, indicate efficacy for the use of this topical Arnica for the relief of soft tissue trauma. Tienchi Ginseng demonstrated the most promising outcomes, with statistically significant differences identified in performance and inflammatory markers in favour of Tienchi Ginseng. Though it cannot be conclusively deemed beneficial for DOMS from this study alone, Tienchi Ginseng warrants further research with larger sample sizes and a similar muscle damage protocol. Finally, Devil’s Claw did not demonstrate beneficial outcomes in regards to DOMS within this study. It actually demonstrated some, perhaps detrimental effects, upon analysis of performance and inflammatory markers. We are unsure of the mechanisms behind these findings, particularly when considering the proposed anti-inflammatory effects of Devil’s Claw. From the literature, Devil’s Claw appears to be beneficial in chronic musculoskeletal conditions however it does not seem to impact on muscle damage and pain resulting from DOMS inducing exercise. The questionnaire study has demonstrated that there is a high usage of CAM among elite Australian athletes, an area up until now that has been unexplored. The onset of CAM use within the Australian athletic population, and the prevalence of CAM use by other professional Australian athletes would be an area to explore in the future. In regards to products which specifically claim to benefit athletes suffering soft tissue trauma such as DOMS, convincing evidence for specific product use was not demonstrated in these studies. Further research involving greater sample sizes may reveal more definitive outcomes, specifically in regards to the use of Tienchi Ginseng. / Doctor of Philosophy (PhD)

Doctor of Philosophy / ABSTRACT Integrative medicine (IM) is a dynamic and increasingly prevalent model of primary health care that combines complementary and alternative medicine with mainstream medicine. This research is about the practice of IM and its value to primary health care in Australia. It locates IM within Australian health care by revealing its processes and outcomes in terms of: practice styles, interactions between practitioners and clients and among practitioners, range of diagnostic and treatment options, and health benefits. In this research I examine the nature of integrative medicine (IM) in co-located primary health care practices and consider the influence that integrating mainstream medicine and CAM can have on the perceived quality of primary health care in Australia. My goal was to contribute the knowledge of the phenomenon of IM through a deeper understanding and interpretation of IM gained by investigating the perceptions of core stakeholders, in this case clients and practitioners of IM. This research was situated in the interpretive paradigm and used two research methodologies: hermeneutics (to interpret the value of IM as reported in the literature) and hermeneutic phenomenology (to understand meanings and significance that clients and practitioners attach to their experiences of IM). Data collection involved the collation of existing literature texts and by cumulative case studies (using semi-structured interviews and observation), focus groups, and key informant interviews. Using a blend of methodologies provided a rich and powerful means of understanding the processes and outcomes of IM through the interpretations of its core stakeholders’ lived experiences. In particular I sought perceptions of clients and practitioners of IM about their health and health care including assessment and treatment options, health outcomes, congruence with beliefs and values, collaborative practices and power sharing. Data analysis was conducted concurrently with and subsequent to data collection so that questioning, observation and textual interpretation were progressively guided by the data. A set of meta-themes emerged from the fusion of findings from all phases of the research. These meta-themes represented answers to key research questions. They are: • Power/authority • Mutual respect • Professionalism • Ontological perspectives • Duty of care. This thesis identifies IM practice styles according to different levels of client agency and degrees of power sharing that exist among CAM and mainstream medical practitioners. A theorised model based on the research findings which depicts quality of health care as a variable consequence of diverse practice styles of IM is produced in two parts: Part 1 acknowledges that IM is a variable phenomenon in practice with different levels of collaboration, power-sharing and quality of health care; Part 2 presents an optimum mode of IM practice. Authentically client-centred health care is at the core of all of these practice styles. This thesis has significant implications for the way IM is practised and for primary health care delivery more broadly. IM that is mutually respectful and genuinely collaborative is flexible, inclusive, and socially relevant and has a substantial and far-reaching contribution to make to the quality of primary health care.

This essay is about the worldview of Swedish people, who experienced healing. I presumed that concepts, which underpin healing phenomena and thereby express the healer’s worldview, could differ from many people’s concepts and worldviews. The question was, if people with a different worldview attended a healing session and experienced positive results for their health, would that give them reasons to reconsider their worldview? Four people were chosen for this research, who had experienced healing and were willing to talk about it. Based on a participating observation, I describe a personal and their healing session, to create an understanding of their experience. Moreover, the healing method Laying on of Hands, which is used during these sessions is described. With the following in-depth interviews, I documented the worldview history of the interviewees, with focus on religious aspects, and compared it with their worldviews after they were convinced, that healing was working for them. In the analysis, coping theory was applied, to describe processes around the healing, which possibly contributed to the change in the patient’s worldview. The results showed a connection between the patient’s goal to regain health and the acceptance of new concepts in their worldview.