>Magister Scientiae - MSc / BACKGROUND: The purpose of this study was to determine use, knowledge and attitudes towards traditional, complementary and alternative medicine (TCAM) in Botswana among people who visit public health facilities. PRIMARY AIM: The primary aim of this study was to establish the attitude towards, knowledge of and use of TCAM among patients utilizing two public health care facilities in Botswana. METHODS: The study was descriptive and quantitative in design. Data were collected using structured questionnaires in two public sector hospitals. Data included demographics of participants, current or past TCAM use, perceptions of efficacy and safety of TCAM and knowledge sources on TCAM. RESULTS: The median age of participants was 38.5 years with the youngest participants being 18 years and oldest participant 78 years. Just more than half (55%) of the participants were female.The majority of participants were single (65.6%) and about a quarter (24.4%) of participants were married. Of the study population 16 (7%) participants had no formal education and 40% had a secondary school education. The prevalence of TCAM use in the 90 study participants was found to be 48.9% of which 16.7% were currently using TCAM and 32.2% had used TCAM in the past. However, this practice could not be correlated with any particular demographic variable. TCAM was most often used either to promote overall wellness or to treat a specific health condition. The TCAM modality that was mostly used was African traditional medicine and other herbals. The majority of TCAM users were satisfied with the effects of TCAM of whom 68.4% of participants found the products very helpful. Most of the respondents (79%) reported that they perceived the products to be very safe. However, the participants were split in their willingness to recommend TCAM to another person. In terms of knowledge, most participants would not use TCAM with other medicines. Yet the majority of participants also indicated that they have never discussed TCAM use with their health care professional. Most participants have been exposed to information on TCAM from family or friends (80.6%). CONCLUSION: The prevalence of TCAM use in Botswana is similar to findings in other parts of the world. These products were primarily used for overall wellness and to treat specific diseases, but this practice could not be attributed to any particular demographic profile. The majority of TCAM users were satisfied with the effects of TCAM. Findings support a need for greater integration of allopathic medicine and CAM, as well as improved communication between patients and caregivers regarding TCAM usage.

Background: This article presents findings from qualitative interviews conducted as part of a research study that trained Acupuncture, Massage, and Chiropractic practitioners' in Arizona, US, to implement evidence-based tobacco cessation brief interventions (BI) in their routine practice. The qualitative phase of the overall study aimed to assess: the impact of tailored training in evidence-based tobacco cessation BI on complementary and alternative medicine (CAM) practitioners' knowledge and willingness to implement BIs in their routine practice; and their patients' responses to cessation intervention in CAM context. Methods: To evaluate the implementation of skills learned from a tailored training program, we conducted semistructured qualitative interviews with 54 CAM practitioners in Southern Arizona and 38 of their patients. Interview questions focused on reactions to the implementation of tobacco cessation BIs in CAM practice. Results: After participating in a tailored BI training, CAM practitioners reported increased confidence, knowledge, and motivation to address tobacco in their routine practice. Patients were open to being approached by CAM practitioners about tobacco use and viewed BIs as an expected part of wellness care. Conclusions: Tailored training motivated CAM practitioners in this study to implement evidence-based tobacco cessation BIs in their routine practice. Results suggest that CAM practitioners can be a valuable point of contact and should be included in tobacco cessation efforts.

No description available.

Chronic pain is common in the United States, with studies suggesting that pain impacts 20% of adults annually. There are many pharmacological agents used to treat pain, including but not limited to opioids, gabapentin, oral analgesics, and antidepressants as analgesics. Acupuncture has been shown to be effective in reducing musculoskeletal pain, headaches, and chemotherapy-induced nausea and vomiting in adults. Children also suffer from chronic pain, but minimal research has examined the use of acupuncture for treatment of pediatric pain. The purpose of this retrospective chart review is to quantify pain reduction in pediatric joint pain treated with acupuncture. The pain scores prior to first and sixth acupuncture treatment for knee pain were compared for 14 pediatric patients. Daily activity and functions scores were obtained from 6 patients. Our results revealed a statistically significant reduction in median pain score (P=0.002). 47% of our sample reported clinically significant pain reduction (> 30% reduction in pain on numerical rating scale (NRS)) and 60% of individuals with baseline moderate-severe pain reported clinically significant pain reduction. The median interference of pain with daily activity was reduced in 5 of 7 daily activities. Our results suggest that acupuncture might be an effective treatment modality for pediatric knee pain and improving quality of life.

<p> The purpose of this thesis was to explore why and how seniors used complementary and alternative medicine (CAM) as well as the meanings they attached to their use of unconventional therapies. To this end, I conducted in-depth, individual interviews with 43 older adults-15 men and 28 women. Based on these data, I found that while all participants recognized the importance of conventional healthcare and continued to use its services, a number of people distrusted and were dissatisfied with medical doctors and treatments as well. Though these negative feelings were not sufficient to push seniors towards CAM, they certainly played a role in their decision making. What informants particularly valued about unconventional approaches was that they allowed them to assert greater control over their health and, to some extent, their aging process. As a result, they viewed CAM as being an integral part of their aging lifestyles and actively incorporated these therapies into their treatment regimens. These findings overall contribute to the relatively scant, albeit growing, body of research on CAM use in later life, seniors' management of regimens, and older patients' dissatisfaction with and distrust of conventional medicine. Theoretically, the findings of this work demonstrate the importance of meaning in later life and specifically, how meanings attached to conventional and unconventional care can influence older adults' health-related perceptions and practices.</p> / Thesis / Doctor of Philosophy (PhD)

BACKGROUND: Complementary and alternative medicine (CAM) use has steadily increased globally over the past two decades and is increasingly playing a role in the healthcare system in the United States. CAM practice-based effectiveness research requires an understanding of the settings in which CAM practitioners provide services. This paper describes and quantifies practice environment characteristics for a cross-sectional sample of doctors of chiropractic (DCs), licensed acupuncturists (LAcs), and licensed massage therapists (LMTs) in the United States. METHODS: Using a cross-sectional telephone survey of DCs (n = 32), LAcs (n = 70), and LMTs (n = 184) in the Tucson, AZ metropolitan area, we collected data about each location where practitioners work, as well as measures on practitioner and practice characteristics including: patient volume, number of locations where practitioners worked, CAM practitioner types working at each location, and business models of practice. RESULTS: The majority of practitioners reported having one practice location (93.8% of DCs, 80% of LAcs and 59.8% of LMTs) where they treat patients. Patient volume/week was related to practitioner type; DCs saw 83.13 (SD = 49.29) patients/week, LAcs saw 22.29 (SD = 16.88) patients/week, and LMTs saw 14.21 (SD =10.25) patients per week. Practitioners completed surveys for N = 388 practice locations. Many CAM practices were found to be multidisciplinary and/or have more than one practitioner: 9/35 (25.7%) chiropractic practices, 24/87 (27.6%) acupuncture practices, and 141/266 (53.0%) massage practices. Practice business models across CAM practitioner types were heterogeneous, e.g. sole proprietor, employee, partner, and independent contractor. CONCLUSIONS: CAM practices vary across and within disciplines in ways that can significantly impact design and implementation of practice-based research. CAM research and intervention programs need to be mindful of the heterogeneity of CAM practices in order to create appropriate interventions, study designs, and implementation plans.

The aim of the research reported here is to answer the following primary research questions: Is the relationship between CAM, the medical profession and the State changing in Portugal? If there has been a change, how and why has such a change occurred? Two CAM therapies, acupuncture and homeopathy, have been chosen as case studies. The main sources of data were in-depth individual interviews and documents. The research sample (n=41) was made of three groups of interviewees: (1) 20 traditional CAM practitioners, (2) 10 orthodox medical doctors not committed to CAM and (3) 11 orthodox medical doctors committed to CAM. This research draws on a neo-Weberian perspective of professions which emphasises the power relations between related occupational groups who seek to gain or maintain power and status in their field of work. This research also makes extensive use of the concept of ‘countervailing powers' (Light, 2010), as it attempts to illuminate the influence of CAM practitioners on Portuguese healthcare, as well as the influence of other powerful players, such as the State, and major corporations, such as pharmaceutical and health insurance companies, on CAM's relationship with the medical profession. On the basis of this research, I argue that the relationship between CAM, the medical profession and the State has changed in Portugal over the last 16 years. I suggest a concept that helps to explain CAM practitioners' recent countervailing actions within the Portuguese mainstream healthcare. This concept is ‘camisation', a process through which everyday human problems are transformed into health problems which are treated in CAM terms and within a CAM framework. Although the main drivers of camisation have been CAM practitioners, I also show how the Portuguese State, the medical profession and the pharmaceutical industry have all been active collaborators in this process, whilst maintaining different interests and constantly bargaining and negotiating to maximise their power and status within the field of healthcare.

BACKGROUND: Randomized controlled trials show acupuncture and acupressure support anesthesia management by decreasing anxiety, opioid requirements and treating post-operative nausea and vomiting. Acupuncture and acupressure have demonstrated clinical usefulness and received governmental support (NIH, PPACA, WHO, U.S. Military), but have not yet diffused into mainstream anesthesia practice. This study examined US anesthesia providers' perceptions of acupuncture and acupressure. METHODS: Ninety-six anesthesiology departments stratified by geographic region (Northeast, South, West, and Midwest) and institution type (university medical centers, community hospitals, children’s hospitals, and VA hospitals) were selected for participation in an anonymous, online survey. The target sample was 1,728 providers of which N = 292 (54% anesthesiologists, 44% CRNAs, 2% AAs) responded yielding an overall 17% response rate. RESULTS: Spearman’s correlation coefficient revealed a statistically significant correlation between acupuncture and geographic region, with the West having the highest predisposition toward acupuncture use (rs = 0.159, p = 0.007). Females are more likely to use acupuncture than men (rs = -.188, p = 0.002). Age yielded a moderate effect size with providers between the ages of 31-50 years old experiencing the best outcomes administering acupuncture (rs = 0.65, 95% CI = 2.79, 3.06). A strong effect size exists between acupuncture and country of pre-anesthesia training (rs = 1.00, 95% CI = 1.08, 1.16). Some providers have used acupuncture (27%) and acupressure (18%) with positive outcomes, however the majority of providers have not used these modalities, but would consider using them (54%, SD = 1.44 acupuncture; 60%, SD = 1.32 acupressure). Seventy-six percent of respondents would like acupuncture education and 74% would like acupressure education (SD = 0.43, SD = 0.44, respectively). Lack of scientific evidence (79%, SD = 0.73) and unavailability of credentialed providers (71%, SD = 0.92) were the primary barriers. CONCLUSIONS: While most U.S. anesthesia providers have not used these modalities, they still report a favorable perception of acupuncture/acupressure’s role as part of an anesthetic and the majority of providers express an interest in receiving education. This study adds to the body of acupuncture and acupressure research by providing insight into anesthesia providers’ perceptions of these alternative medicine modalities.

Student Number : 8229351 - MSc (Nursing) research report - Faculty of Health Sciences / The use and teaching of CAM (complementary and alternative medicine) therapies is a growing trend worldwide in the pursuit of health and the amelioration of some disease problems. Chronic, insoluble problems, stress (both mental and physiological), and pain are particularly the target of these therapies. In February 2001, South Africa became a world leader when she passed legislation promoting ten traditional or complementary and alternative therapies into professionalism. The purpose of this study was to assess the trends and patterns of use of senior nursing students of CAM therapies, and their intention to use such CAM therapies on their patients, or to refer their patients to practitioners of CAM therapies. A self-report survey was used to obtain this data, partly constructed from knowledge gathered in the literature review. Senior nursing students from three teaching institutions in Johannesburg participated in the survey. A pilot study to test the feasibility of the study and the reliability of the instrument was carried out at one of these three institutions. The group that participated in the pilot was not the same group that was later used as subjects at this institution. The pilot test was then subjected to a Peason's Product-Moment Correlation test to assess testretest reliability. Pearson's r was found to be 0.8, which shows high reliability of the instrument. Descriptive statistics (frequencies, means, and proportions) were used to summarize and present the results. The main results are as follows. A much larger group of respondents saw allopathic practitioners than CAM practitioners for their personal health problems and to maintain their health. Knowledge of CAM therapies was reported to be fairly low, though this may be due to the number of therapies presented for consideration. A large percentage of the respondents was interested in learning about, and even practicing CAM therapies on their patients, and in referring their patients to CAM practitioners or being able to advise them about CAM therapies and remedies appropriately. Given these results, with regard to nursing education, it was suggested that at least an introductory course to the basic tenets of CAM therapies and "holistic" or "body-mind medicine", needs to be presented to all student nurses. The problems inherent in developing adequate and relevant research avenues for these complex subjects, and an understanding of a range of the most commonly practiced CAM therapies needs to be included at neophyte nursing level. Focussed suggestions are made in the body of the report. Focussed suggestions are also made with regard to future research, both within the field of nursing and related allopathic disciplines possibly interested in incorporating aspects of CAM therapies within their own bodies of knowledge, and outside these disciplines. Suggestions relevant to the teaching and practice of a few CAM therapies practiced by the researcher, and of pharmacological and other possible avenues of research relevant to some of these therapies, will be made in the form of further articles submitted to the professional magazines of the CAM therapies concerned.

In Lebanon, estimates of Complementary and Alternative Medicine (CAM) use among college students are not available. CAM practices are not well regulated and some products contain unsafe substances. The purpose of this study was to estimate the prevalence and predictors of CAM use among Lebanese college students using the health belief model. A quantitative cross sectional research design was used. An online survey was administered to 126 Lebanese college students with the aim of determining the most important predictors of CAM use. A majority (89%) of surveyed students reported the use of CAM in the last 12 months. Based on the findings of a multiple logistic regression analysis, perceived susceptibility (OR = 1.781), perceived barriers (OR =.809), and cues to action (OR = 1.650), 95% CIs [1.185, 2.678], [.658, .995], [1.049, 1.821], respectively, significantly predicted CAM use. Results indicate that people who perceive themselves more susceptible to diseases, who do not perceive barriers to CAM use, and who follow more cues to action are more likely to use CAM than others. These factors provide pathways for facilitating positive social change by developing stricter governmental policies to ensure consumer safety and to promote high quality products, and by driving the development of public awareness interventions about CAM use and related health risks.