Objective: From a patient-centered perspective, this study sought to explore cancer patient experiences using integrative health techniques, while undergoing or after having completed conventional cancer therapy. Methods: Recruitment and data collection both occurred within the Supportive Care Medicine Department of a comprehensive cancer center in the southeastern United States. The primary collection method was semi-structured interviews, of which 13 were conducted. Results: Patients using integrative therapies experienced a variety of physical and mental/emotional benefits from their chosen therapy, such as management of lymphedema and nerve damage, increased mobility, and improved self-confidence. Conclusion: Integrative therapies can provide many benefits to patients in mitigating treatment side effects and other cancer related symptoms. CAM practitioners themselves played an important role in post-treatment cancer support; both by acting as a health educator and by administrating the therapy itself.

<p>Alongside the complementary and alternative medicine movements, a new concept is emerging: integrative medicine. Though more and more authors have begun to use this term, they use it to refer to widely varying concepts of health care. This study begins with a theoretical look at integration and continues with an examination of current integrative efforts. These general discussions are followed by the presentation of the situation in Sweden, and at the Vidarklinik in particular. Finally the study turns to an empirical study investigating the communication between the Vidarklinik and the outside biomedical system. The research suggests a much more comprehensive picture of integrative medicine than those put forward by most authors and finds that to create and maintain an integrative system, all the levels of health care must be actively engaged in the system and the entire spectrum of care must be coordinated for the patient. Attempts at integration are found in diverse local efforts, which are all limited by lack of cooperation between different levels of health care. The study of communication at the Vidarklinik in Sweden illustrates that communication is crucial between all levels of health care in order for even relatively localised efforts in integration, and further that various factors limit whom various individuals and groups can communicate with, while in-person dialogue mitigates some of these factors.</p>

Historiskt har den medicinska professionen sökt exklusiva rättigheter att praktisera i en miljö där många olika yrkesgrupper fanns. I Sverige har detta lett till att komplementär och alternativ medicin (CAM) hamnade utanför den etablerade sjukvården, vilket inneburit en bristfällig kunskap om hur bl.a. CAM terapeuter arbetar. Användning av alternativ medicin har ökat i Sverige vilket motiverar att studier genomförs för att få bättre kunskap om yrkets utövande. Syftet med uppsatsen är att beskriva CAM terapeuters praktikmönster och inställning till samarbete med traditionell skolmedicin. Utifrån en litteraturstudie utarbetades en enkät som skickades till 102 CAM terapeuter i Sverige för att undersöka deras praktikmönster och sociodemografiska egenskaper. 63 terapeuter (62 %) svarade, varav 59 uppfyllde forskningskriterierna och kunde delta i de fördjupande telefonintervjuer som följde efter enkätstudien och som syftade till att ta reda på deras syn på samarbete med den skolmedicinska sjukvården. Resultaten av undersökningen visade att 55 %, av de 59 intervjuade var kvinnor, 10 % hade legitimation i andra sjukvårdsyrken, 69 % arbetade ensamma med i snitt 24 patienter i veckan. 79 % var positiva till samarbete med skolmedicinen och 37 % hade redan regelbunden kontakt med läkare. Intervjuerna visade att CAM terapeuter generellt ansåg att det var viktigast att patienters behov och önskemål beaktades i utformningen av den vård som erbjöds. Patienternas kostnad för behandling, respekt för CAM terapeuter, legitimation, konkurrens, samarbete med och kunskap om de olika yrken var andra viktiga faktorer som belystes ur olika perspektiv. Studien ger ny kunskap om CAM i Sverige och avslöjar många hinder som gör samarbete mellan skolmedicin och CAM till en utmaning för CAM terapeuter. Resultaten från denna studie kan hjälpa till att utveckla en sjukvård som omfattar olika utövare av läkekonsten / This study aims to describe the practice patterns of complementary and alternative medicine (CAM) practitioners and their collaboration with traditional medical professionals in Sweden. Historically, the medical profession has dominated medical practice in an environment of different healing professions. This domination placed CAM professionals outside the established medical system. Consequently, information about CAM is inadequate. Since today’s patients increasingly seek consultations with CAM practitioners, the need for a better understanding of these professions has grown.       To investigate the practice patterns and sociodemographic characteristics of CAM practitioners, we developed a literature-based questionnaire and sent it to 102 CAM practitioners. Among the 63 practitioners (62%) who replied, only 59 matched our research criteria for participating in further telephone interviews that allowed them to state their opinions on collaborating with conventional medical professionals.       Fifty-five percent of the telephone interviewees were women, 10% were licensed in other medical professions, and 69% worked in solo practices, seeing 24 patients per week on average. Furthermore, 79% felt collaboration would be positive, and 37% had already established regular contacts with medical doctors. CAM practitioners generally considered patients’ needs and desires to be an essential component of healthcare provision. They also elucidated the importance of treatment costs, respect for CAM professionals, licensing, competition, collaboration, and knowledge of a variety of professions.  This study provides new information about the challenges faced by CAM profession in Sweden and reveals many obstacles to collaboration. Our results can assist in the development of a health care system that includes a variety of different professions. / <p>ISBN 978-91-85721-79-5</p>

Alongside the complementary and alternative medicine movements, a new concept is emerging: integrative medicine. Though more and more authors have begun to use this term, they use it to refer to widely varying concepts of health care. This study begins with a theoretical look at integration and continues with an examination of current integrative efforts. These general discussions are followed by the presentation of the situation in Sweden, and at the Vidarklinik in particular. Finally the study turns to an empirical study investigating the communication between the Vidarklinik and the outside biomedical system. The research suggests a much more comprehensive picture of integrative medicine than those put forward by most authors and finds that to create and maintain an integrative system, all the levels of health care must be actively engaged in the system and the entire spectrum of care must be coordinated for the patient. Attempts at integration are found in diverse local efforts, which are all limited by lack of cooperation between different levels of health care. The study of communication at the Vidarklinik in Sweden illustrates that communication is crucial between all levels of health care in order for even relatively localised efforts in integration, and further that various factors limit whom various individuals and groups can communicate with, while in-person dialogue mitigates some of these factors.

This dissertation examined health care utilization patterns across conventional health care (CHC), complementary and alternative medicine (CAM), and public health care (PHC) systems among Canadians aged fifty and older. I argued that utilization research is currently limited by a primary focus on discrete use of health care services, largely within the CHC system (i.e., medical doctors, specialists, hospitals). However substantial growth in use of CAM and PHC, particularly among late middle-age cohorts, suggests the need to widen the research lens from discretionary service use within health care systems to include medical pluralism or use across health care systems. To address the lack of research on medical pluralism and the need for a comprehensive overview of service use, I used two different strategies to create discrete patterns of service use and non-use. To frame the predictors of these patterns, a medical pluralism paradigm was proposed, which suggests that there are distinct social location and health characteristics that may explain use across health care systems. Five hypotheses were tested using data pooled from two cycles of the Canadian Community Health Survey (Cycles 2.1 [2003] and 3.1 [2005]) to create an overall sample (n=117,824). Results from the deductive (variable oriented) and inductive (person centred) strategies were compared. Differences in both the number and form of patterns are apparent. Across both strategies, the most common pattern is dual use of CHC (medical visits, specialist visits) and PHC (flu shots, sex-specific screening) but not CAM (chiropractors, other CAM providers). Consistent with the literature, women use more types of services overall than do men. The gender effect is significantly mediated by age: older men are less likely to use services across the three health care systems than older women. Strong evidence for a socioeconomic gradient in medical pluralism is also found. Higher levels of income and education increase the likelihood of using services across the three health care systems compared to low and middle levels of both income and education. The relationship between race and health service use was much less significant. Long-term immigrants demonstrate tri-use patterns close to those of Canadian born individuals; however, service differentials remain even after controlling for health needs, in favour of native-born Canadians. Medical pluralism is also associated with health related-need as support was found for both illness and wellness care. Lastly, regional differences point to a greater likelihood of medical pluralism in western Canada, but not always in urban areas. In future, a longitudinal examination of medical pluralism is necessary and would help establish the sequencing of services and how services are used in relation to the disablement process. Health policy would thus benefit from insight into the extent of service duplication for specific conditions and clarify the role of medical doctors in referral processes. / Graduate

Minority groups experience disproportionately worse health outcomes. An identified solution is to increase the number of minorities providing healthcare in their own communities. Primary care complementary and alternative medicine (CAM) providers are a potential resource. Many investigators have demonstrated the efficacy of science-based pipeline programs for increasing the roles of students in allopathic health professions. Whether these programs influence matriculation of minorities into a CAM university is unknown. The main purpose of this study was to gain an understanding of a pre-college science academy at a CAM university and determine whether the experience increased interest in and motivation for CAM careers. It was also important to learn more about what factors may facilitate or impede minority student matriculation in a CAM university. In this phenomenological study, a mixed purposeful sampling strategy was used to select 9 students who had participated in a science academy at a CAM university. Individual in depth, semi-structured, interviews were conducted and analyzed using a process of inductive analysis. The results indicated that barriers to college matriculation included cost and the complexity of the process. The desire to elevate status steers some minorities who use CAM modalities as their indigenous health practice, towards high prestige allopathic careers. Participation in the science academy increased interest in and utility of CAM, but did not change preconceived career choices. These results contribute to the existing literature and can enrich social change initiatives by increasing the number of minorities providing healthcare in their own communities, and further understanding of the factors that influence underrepresented minority career choices.

BACKGROUND:Available measures of patient-reported outcomes for complementary and alternative medicine (CAM) inadequately capture the range of patient-reported treatment effects. The Self-Assessment of Change questionnaire was developed to measure multi-dimensional shifts in well-being for CAM users. With content derived from patient narratives, items were subsequently focused through interviews on a new cohort of participants. Here we present the development of the final version in which the content and format is refined through cognitive interviews.METHODS:We conducted cognitive interviews across five iterations of questionnaire refinement with a culturally diverse sample of 28 CAM users. In each iteration, participant critiques were used to revise the questionnaire, which was then re-tested in subsequent rounds of cognitive interviews. Following all five iterations, transcripts of cognitive interviews were systematically coded and analyzed to examine participants' understanding of the format and content of the final questionnaire. Based on this data, we established summary descriptions and selected exemplar quotations for each word pair on the final questionnaire.RESULTS:The final version of the Self-Assessment of Change questionnaire (SAC) includes 16 word pairs, nine of which remained unchanged from the original draft. Participants consistently said that these stable word pairs represented opposite ends of the same domain of experience and the meanings of these terms were stable across the participant pool. Five pairs underwent revision and two word pairs were added. Four word pairs were eliminated for redundancy or because participants did not agree on the meaning of the terms. Cognitive interviews indicate that participants understood the format of the questionnaire and considered each word pair to represent opposite poles of a shared domain of experience.CONCLUSIONS:We have placed lay language and direct experience at the center of questionnaire revision and refinement. In so doing, we provide an innovative model for the development of truly patient-centered outcome measures. Although this instrument was designed and tested in a CAM-specific population, it may be useful in assessing multi-dimensional shifts in well-being across a broader patient population.

This study investigates the promise of using therapeutic adventure as an alternative therapeutic approach to address a public health issue: Veterans reticence towards seeking mental health assistance, despite their rising rates of mental health issues. To examine how the intersection between conformity to traditional masculine norms and Outward Bound for Veterans (OB4V) programming impacted psychosocial development, a quasi-experimental, longitudinal design was implemented on 159 male Veterans. The primary goals were twofold: 1) to determine whether improvement in six therapeutic outcome variables occurred due to the OB4V intervention; 2) to discover whether male Veterans’ level of conformity to traditional masculine norms influenced change in the therapeutic outcome variables. Outcome variables included: 1) mental health status; 2) personal growth initiative; 3) attitudes towards seeking professional psychological help; 4) psychological mindedness; 5) restriction of emotions; 6) subjective wellbeing. Results indicated a significant effect of treatment, suggesting that the OB4V treatment promoted Veterans improvement in all the therapeutic outcome variables, except psychological mindedness. Findings also showed that the significant effect of treatment was associated with Veterans’ improvement in therapeutic outcome variables over all time points irrespective of their level of conformity to traditional masculine norms. / text

Les objectifs de ce travail étaient d’évaluer la prévalence vie entière des traitements à visée psychotrope et les caractéristiques associées à cet usage dont l’adéquation avec l’existence de troubles psychiatriques. Les travaux ont été réalisés à partir des données issues de l’enquête Santé Mentale en Population Générale sur un échantillon de 36 785 adultes représentatifs de la population générale française. Un tiers des sujets a rapporté avoir fait usage d’au moins un traitement psychotrope au cours de la vie. L’inadéquation diagnostic-traitement est retrouvée dans le sens « usage en l’absence de trouble psychiatrique » aussi bien que dans le sens « absence d’usage en présence de trouble identifié ». Ainsi, seul un tiers des sujets avec un diagnostic de trouble dépressif récurrent a fait usage d’un traitement antidépresseur ou thymorégulateur. Concernant l’utilisation de traitements alternatifs, seuls 1,3 % des personnes rapportent un usage de traitement homéopathique à visée psychotrope. Ces traitements sont principalement utilisés par des personnes présentant un trouble anxieux en association avec un traitement psychotrope conventionnel. Des études ultérieures documentant l’ensemble des traitements à visée psychotrope utilisé dans le traitement des symptômes psychiques permettraient d’affiner les résultats sur l’adéquation diagnostic-traitement et d’estimer le nombre de sujets évitant le recours aux traitements conventionnels par l’utilisation d’alternatives thérapeutiques. / The aims of this work were to assess the lifetime prevalence of psychotropic drug use and the characteristics associated with use, particularly the congruence with psychiatric diagnoses. The studies were performed using the database from the survey Mental Health in the General Population including 36 785 persons representative of the French general population. One out of three subjects reported a lifetime use of psychotropic treatment. The non-congruence between diagnosis and psychotropic drug was observed in the pattern “use without psychiatric disorders” as well as in the pattern “no use with psychiatric disorders”. So, only one out of three persons with recurrent major depressive disorder reported having used an antidepressant or a mood stabilizer. Regarding complementary and alternative medicine use, only 1,3% of persons reported use of homeopathic treatment for psychiatric symptoms. These treatments were mainly used by persons with anxiety symptoms in association with conventional psychotropic drugs. Further studies assessing the all the treatments used for psychiatric symptoms would allow to refine the results on the congruence between diagnosis and psychotropic drug and to estimate the number of persons avoiding use of conventional psychotropic drugs by using complementary and alternative medicine.

Les progrès réalisés en immunologie ont orienté les recherches vers des approches et des stratégies de plus en plus prometteuses et innovantes afin de mieux manipuler la réponse immunitaire. Le but de nos recherches est la prévention et le traitement des maladies liées aux dysfonctionnements du système immunitaire, telles que les maladies auto-immunes, inflammatoires et malignes. Bien que l’inflammation constitue un processus physiologique indispensable au maintien de l’homéostasie suite à une infection ou à une lésion, elle est également associée à des pathologies infectieuses, auto-immunes et tumorales. Les stratégies thérapeutiques les plus utilisées pour traiter l’inflammation sont basées sur la neutralisation des médiateurs inflammatoires par des anticorps, des antagonistes moléculaires, des immunoglobulines intraveineuses, des corticostéroïdes, des médicaments anti-inflammatoires non stéroïdiens. En plus des traitements mentionnés, des produits issus de la phytothérapie ont été largement utilisés afin d’atténuer l'inflammation et la douleur dans plusieurs maladies inflammatoires et dans le cancer. Depuis des décennies, les préparations de Viscum album, connu sous le nom de « gui européen », sont largement utilisées dans le traitement du cancer comme thérapie auxiliaire. Bien que les mécanismes d’action soient partiellement connus, plusieurs hypothèses ont été proposées. En effet, les mécanismes anti-tumoraux du Viscum album impliquent des propriétés induisant une cytotoxicité, l'apoptose, l'inhibition de l'angiogenèse et plusieurs autres mécanismes immunomodulateurs. Ce travail décrit un nouveau mécanisme anti-inflammatoire de Viscum album, qui participe à l’effet thérapeutique de ces préparations. De plus, l’effet bénéfique anti-inflammatoire observé est associé à l’inhibition des voies pro- inflammatoires de COX2 et PGE2 dans les cellules épithéliales issues d’adénocarcinome du poumon. Ce travail a identifié un des mécanismes moléculaires de Viscum album associé à son effet anti-inflammatoire participant à ses bénéfices thérapeutiques. Ainsi, ces préparations pourraient être utilisées en combinaison avec d’autres traitements dans des maladies inflammatoires et dans le cancer. / Recent advances in immunology research have led us towards more promising approaches and strategies to manipulate the immune response to prevent or treat the diseases related to immune dysfunction such as autoimmune, inflammatory pathologies and malignant diseases. Although, immuno inflammation is a basal physiological phenomenon required to eliminate the causative agent and to initiate the healing process, it is a physiopathological symptom in a diverse conditions of infectious, autoimmune and tumoral origin. Various therapeutic strategies have been developed in order to reduce inflammation and pain, including the treatment with cytokine neutralizing antibodies, molecular antagonists, intravenous immunoglobulins, corticosteroids, non-steroid anti-inflammatory drugs (NSAID) and several others. In addition to these well known anti-inflammatory therapeutic strategies, treatment with various phytotherapeutics has also contributed enormously to control inflammation and pain, associated with various severe inflammatory disorders and cancer. Viscum album (VA) preparations, commonly known as European mistletoe, are extensively used as complementary therapy in cancer for decades. However the mechanisms of action have been partially understood. Several mutually non-exclusive mechanisms have been proposed such as anti-tumor properties which involve the cytotoxic properties, induction of apoptosis, inhibition of angiogenesis and several other immunomodulatory mechanisms. This study reveals anti-inflammatory mechanism as another important mechanism of action of these phytotherapeutics, which is responsible for their therapeutic benefit and addresses the molecular mechanisms in the pro-inflammatory axis of COX-2 and PGE2 using in vitro experimental model of human lung adenocarcinoma. The present work contributes for a better understanding of mechanisms of action of Viscum album preparations underlying their therapeutic benefit and allows us to revitalize the therapeutic strategies used in treatment of inflammatory disorders and cancer.