Knowledge, attitude and practice of complementary and alternative medicines for diabetes

OBJECTIVES: To investigate the current status of knowledge, attitude and practice of patients with diabetes relating to complementary and alternative medicine (CAM) in an Indian community, and to determine perceptions about the use of CAM and factors influencing knowledge and usage. SETTING: Endocrine clinic of Swaroop Rani, Nehru Hospital, Allahabad, India. STUDY DESIGN: Hospital-based cross-sectional study. PARTICIPANTS: Patients with diabetes attending the clinic for the first time. SAMPLE SIZE: A sample of 493 study participants selected by systematic sampling from a population of 6094 patients with diabetes. STUDY VARIABLES: Age, socio-economic status, educational status, religion, family history of disease, knowledge and practice of CAM, reasons for using CAM, method of use and perceived relief. STATISTICAL ANALYSIS: Normal test of proportions, chi(2) test, Kolomogorov-Smirnov test. RESULTS: Awareness of CAM among patients was high (71%). High prevalence of CAM use was found (67.7%) among all participants, and 95% among participants aware of CAM, mostly using 'naturopathy' (97.3% among users). No significant gap (P>0.10) between knowledge and practice in different categories was observed. Desire for quick and additional relief was the most common perceived reason for using CAM (86.8%). Higher levels of education and socio-economic status were significant positive correlates of CAM use. Knowledge of CAM was gained mainly from friends and neighbours. About 30% of users adopted CAM without allopathic treatment earlier. Only 42.2% of users perceived some relief by using CAM. Lowering of blood sugar was the most common perceived relief. CAM, along with diet control and exercise, resulted in maximum degree of satisfaction (61.9%) experienced by users. No relief was experienced by 53.6% of users of 'naturopathy'. CONCLUSIONS AND SUGGESTIONS: Use of CAM in diabetes is highly prevalent despite high levels of disappointment after its use. In this study, we suggest the need for health education relating to CAM and self-care in diabetes. Use of CAM should be explored with patients before clinical decisions are made.     

Oncologists' and specialist cancer nurses' approaches to complementary and alternative medicine and their impact on patient action

High levels of use of complementary and alternative medicine (CAM) have been consistently reported amongst cancer patients over recent years. This is occurring in the context of an apparent increase in sources of information on therapeutic alternatives and a growth in the range of those claiming professional expertise in the field. To date there has been little research on patient experience of discussions about CAM with biomedical cancer specialists in this increasingly complex social environment. This paper addresses three issues: patient experience with cancer specialists; the significance of that experience for patient engagement with CAM; and the nature and significance of inter-professional dynamics. It draws on the results of a qualitative study with cancer patients in the UK. In-depth interviews with 80 purposively sampled patients, incorporating a range of disease types and stages, were conducted. Patients reported three main types of approach by oncologists: explicit or implicit negativity; supportive ambivalence; and, pragmatic acceptance. Crucially, patients' accounts suggest that the type of approach adopted influences (though does not determine) patient action. Specialist cancer nurses emerged as potentially powerful mediators between oncologists and patients. Despite the apparent potential for influence from multiple information sources and 'experts', on the basis of this study we would argue that oncologists remain crucial to patient engagement with CAM. However, this is not to argue that the influence is a simplistic one. Where patient and medical perspectives diverge, strategic alignment with specialist nurses may help patients make choices which conflict with perceived advice.     

The inequalities of medical pluralism: Hierarchies of health, the politics of tradition and the economies of care in Indian oncology

India has an eclectic health system that incorporates biomedical as well as traditional, complementary and alternative medicine (TCAM). Our understanding of the co-existence of these therapeutic modalities in this diverse, postcolonial and developing nation is extremely limited, and in the context of cancer care, to our knowledge no sociological work has been carried out. Contemporary Indian oncology represents a fascinating site for examining the interplay and articulation of forms of tradition/modernity, economic progress/structural constraint and individual beliefs/cultural norms. In a context of an increase in the prevalence and impact of cancer in an ageing Indian population, this paper reports on a qualitative investigation of a group of oncology clinicians' accounts of ‘pluralism’ in India. The results illustrate the embeddedness of patient disease and therapeutic trajectories in vast social inequalities and, indeed, the intermingling of therapeutic pluralism and the politics of social value. We conclude that notions of pluralism, so often espoused by global health organisations, may conceal important forms of social inequality and cultural divides, and that sociologists should play a critical role in highlighting these issues.     

Electrodermal mapping: A new technology

AIM: To provide the first objective data to show that the electrical conditions of an acupuncture point and a non acupuncture point are different.METHODS: A newly developed multi-channel skin resistance measuring system is used to characterize the variability in electrical resistance measurements in and around an acupoint, a non-acupoint and a scar. The system measures the electrical skin resistance at 48 points, both absolutely and continuously. The study was performed at the Medical University of Graz in 10 male volunteers, aged between 20 and 30 years and of eurocaucasian descent. With software developed along with the hardware, both a high-resolution measurement and a graphical presentation of possible changes in electrical resistance in the region of interest are possible.RESULTS: Using the new electrodermal mapping system, differences in skin resistance of an acupoint, a non-acupoint and around a scar could be observed. The values varied within a range of up to 100-500 kOhm. Thermography measurements for control reasons in the same spot did not show these changes.CONCLUSION: Electrodermal mapping is an innovative method for highly precise skin resistance measurements.     

A quackery with a difference-new medical pluralism and the problem of 'dangerous practitioners' in the United Kingdom

The figure of the 'miracle cure'-peddling quack pretending spectacular properties for worthless tonics is iconic. From their 19th century traveling wagon shows to their 21st century Internet spam scams, hucksters and cranks have been consistently targeted by health authorities as a danger to public health. Yet, in this paper, I argue that this is only one form that the problem of 'quackery' has taken in the past two centuries or so in the United Kingdom. Just as Roy Porter showed how the mid-19th century professionalization of medicine gave rise to a 'quackery with a difference' as a whole range of new medical movements-homoeopathy, hydropathy, medical botany, mesmerism-actively denounced allopathic or modern medicine, I will suggest that the late 20th century birth of 'complementary and alternative medicine' (CAM) has resulted in yet another transformation in quackery. By examining the ways in which regulatory authorities in the UK have come to address what is invariably described as a 'growing interest in CAM', I will show how the problem of quackery today is increasingly located in an ethical field of practitioner competency, qualifications, conduct, responsibility and personal professional development, almost (but not quite) regardless of the form of therapy in question.     

上海市卢湾区1974～2002年糖尿病死亡率分析

[目的 ]　了解卢湾区糖尿病死亡情况 ,为确定社区糖尿病综合防制策略和工作重点提供参考。　 [方法 ]　根据卢湾区 1974～ 2 0 0 2年死因资料 ,对不同年份、性别、年龄、季节、地域人群的糖尿病死亡率及变化趋势进行描述性统计与分析。　 [结果 ]　 2 9年来 ,卢湾区糖尿病死亡率及男女糖尿病死亡率基本上呈波动性的上升趋势 ,女性高于男性 ,随年龄增高而增高 ,冬季死亡率高于其他季节 ,与人文社会环境因素有关。　 [结论 ]　综合、系统、高效开展社区糖尿病防治 ,需依托健全的社区卫生服务网络 ,加强群体化和个体化预防保健和危险因素监测评价是减少发病与死亡的关键 ,老人和妇女是重点对象。     

Interprofessional collaboration within Canadian integrative healthcare clinics: Key components

Research shows that interprofessional collaboration has become an important factor in the implementation of effective healthcare models. To date, the literature has not focused on the collaboration between medical doctors and complementary and alternative medicine (CAM) healthcare practitioners, an example of interdisciplinary collaboration called integrative healthcare (IHC). Drawing on in-depth, semi-standardized interviews conducted with 21 practitioners working in Canadian IHC clinics, this paper explored and interpreted how IHC is experienced by those working in Canadian IHC clinics. The interview questions and analysis were guided by the Input, Process, Output conceptual framework drawn from the organizational management theory (McGrath, J. E. (1964). Social psychology: A brief introduction. New York: Holt, Rinehart and Winston.) to study collaboration within teams.We found that constructs contributing to collaboration included practitioners' attitudes and educational background, as well as external factors such as the healthcare system and financial pressures. Major processes affecting collaboration included communication, patient referral and power relationships. These determinants of collaboration were found to result in learning opportunities for practitioners, modified burden of work and ultimately, higher affective commitment toward the clinic. These constructs serve as a guide for further investigation of interprofessional collaboration within an IHC clinic.This exploration of interprofessional collaboration in IHC identified a broad array of key factors associated with interprofessional collaboration. These factors are critical to better understand the functioning of IHC clinics, and provide guidance for creation or maintenance of successful clinics.     

Disruption in the leptin-NPY link underlies the pandemic of diabetes and metabolic syndrome: new therapeutic approaches

Multidisciplinary research from my and my colleagues' laboratory has shown that disruption at various levels of leptin signaling to the interactive hypothalamic network of neuropeptide Y (NPY) and cohorts contributes to the antecedent pathophysiologic sequelae of the disease cluster of the metabolic syndrome. Disruptions in NPY signaling due to high or low abundance of NPY and cognate receptors dysregulate the homeostatic milieu to promote hyperinsulinemia, hyperglycemia, fat accrual, and overt diabetes. Hyperleptinemia induced by consumption of energy-rich diets inhibits leptin transport across the blood-brain barrier and thereby produces leptin insufficiency in the hypothalamus. Sustained leptin insufficiency results in loss of hypothalamic restraint on pancreatic insulin secretion and diminished glucose metabolism and energy expenditure. This chain of events culminates in hyperinsulinemia, hyperglycemia, and diabetes. Our recent studies have shown that increasing the supply of leptin centrally by gene therapy reinstates the restraint on hypothalamic NPY signaling and ameliorates diabetes and the attendant disease cluster of the metabolic syndrome. Thus, newer therapies that would enhance leptin transport across the blood-brain barrier in a timely manner or reinstate leptin restraint on NPY signaling through central leptin gene therapy or pharmacologically with leptin mimetics are likely to curtail the pathophysiologic sequelae of diabetes and related ailments of the metabolic syndrome.     

Quality of life of participants in a mind-body-based self-development course: A descriptive study

OBJECTIVE: A cross-sectional survey of quality of life of people attending a self-development course involving psychophysiological mind-body medicine (MBM) activities. DESIGN: A questionnaire study using a health-related quality of life (HRQoL) instrument, the SWED-QUAL, with 13 subscales scored 0-100, and questions about utilisation of alternative and standard health care, medication and sick leave. SETTING: A training centre for MBM, established 15 years ago. STUDY GROUP: One hundred and seven eligible course attendants (response rate 88%, age 20-70 years) during the year 2000 assessed their HRQoL just before entering the course. Attendance was self-initiated, without referral. The results on HRQoL were compared with those of control subjects from the general Swedish population. RESULTS: Six of the thirteen HRQoL subscales were strongly and significantly reduced (p < 0.0001) in the study group: Negative affectivity, Role limitation due to emotional health, Positive affectivity, Cognitive functioning, Family functioning and Marital functioning. Long-term sick leave (>6 months) was three times as frequent in the study group as in the general population. Use of psychotropic medication was slightly increased compared to the general population, at least among the younger male participants. The education level was high, health care utilisation was average and body functioning was good. CONCLUSIONS: This group of well-educated men and women gave their emotional health an unexpectedly low rating, on a par with that given by people with chronic diseases.     

De‐legitimising complementary medicine: framings of the Friends of Science in Medicine‐CAM debate in Australian media reports

Complementary and alternative medicine (CAM) has developed into a complex and formidable commercial, sociocultural and political force in Australia, and given its influence, it is a relevant subject for scholars, health practitioners, health communicators, journalists, policy‐makers, and consumers of healthcare products and services. This research will consider a relative newcomer to the claims‐making space about CAM in the Australian health media‐scape; the Friends of Science in Medicine (FSM), an activist group of medical practitioners, researchers, and scientists, founded in late 2011. Using content analysis supported by NVivo, I searched for articles specifically referring to FSM and measured the patterns and frequencies of media frames, intonation and sources that are featured in Australian mainstream news reports between December 2011 and April 2017. The negative headlining and intonation of reports predominated, along with framing CAM as part of a lucrative, undisciplined and unethical industry as well as an illegitimate healthcare approach, more broadly. The findings offer insight into how journalists respond, replicate or reconstruct the framings that are provided by an influential and elite group of medical practitioners and scientists, and readdresses issues surrounding the need for more critical health reporting in Australia.     

Negotiating competency, professionalism and risk: the integration of complementary and alternative medicine by nurses and midwives in NHS hospitals

This qualitative interview study examined the use of complementary and alternative medicine (CAM) by nurses and midwives in NHS hospital settings in 2008 in the UK. It showed that the groundswell of interest in CAM in the 1990s had diminished by this time due to changes to policy and funding, and increasingly stringent clinical governance. Nevertheless, CAM provided an opportunity for committed and self-motivated practitioners to extend their therapeutic repertoire and develop affective dimensions of practice. However, the integration of CAM did not afford the autonomy, status and material gains traditionally associated with a collective professional project. In practice, occupational strategies were individualistic, and grounded in the assertion of competency through expressions of professionalism rather than the credentialism which underpins classic professionalisation. Central to these strategies was CAM related risk, which became a means by which to claim occupational space. However, the extent to which the adoption of CAM enhanced the nurses' and midwives' roles was limited by traditional medical authority; the uncertain status of CAM knowledge; and the absence of collective strategies - which together often left practitioners in a position of vulnerability.     

Low level of quality of life in patients with mental and behavioral disorders wanting complementary and alternative (<Emphasis Type="Italic">kampo</Emphasis>) therapy

Objective To compare the quality of life (QOL) in patients with and without mental and behavioral disorders wanting to receive kampo, a type of complementary and alternative medicine (CAM), we investigated the QOL of patients using the World Health Organization Quality of Life Brief Scale (WHOQOL-BREF). Methods Seven hundred and twenty-nine outpatients with various diseases or disorders wanting to receive kampo therapy were recruited in the study. Two hundred and ninety-four patients (F-group) had mental or behavioral disorders. For these 729 patients, QOL was rated on the WHOQOL-BREF Japanese version. Results The average WHOQOL-BREF score of F-group (2.93 ± .54) was significantly lower than that of controls (3.23 ± .53). Especially, the average WHOQOL-BREF score of the 135 patients who had already been treated with modern medicines and wanted to be treated with kampo formulas to augment modern medicines (2.77 ± .55) was significantly lower than that of other patients. Conclusion QOL in patients with mental and behavioral disorders wanting to be treated with kampo who had already been treated with modern medicines was lower than that in patients with general medical conditions or with mental or behavioral disorders not treated with modern medicine.     

Well-being and treatment satisfaction in adults with diabetes: A Swedish population-based study

In order to implement the St Vincent Declaration programme, instruments for quality assurance of medical outcomes as well as measures of psychological outcomes of diabetes care had to be developed. This paper presents baseline values for three questionnaires measuring psychological Wellbeing, Treatment Statisfaction and General Health among a representative sample of adult people with diabetes in Sweden consisting of 423 individuals of which 153 were insulin treated and 270 were diet/tablet-treated.Cronbach's indicated that each of the Well-being and Treatment Satisfaction subscales was internally reliable, alphas ranging from 0.66–0.88. Factor analysis resulted in identification of five subscales (depression, anxiety, positive well-being, treatment satisfaction and metabolic control). There was no relation between any of the quality of life subscales with HbA1c, BMI, duration of diabetes, frequency of blood glucose tests per day, insulin regimens or diabetic complications. Females reported a more negative impact of diabetes on daily life compared with males (p<0.001). In conclusion, the Well-being and Treatment Satisfaction scales are reliable for quality assurance purposes in diabetes while the briefer general health instrument provides a useful assessment of the global impact of a chronic disease.     

Trends in access to complementary or alternative medicines via primary care in England: 1995-2001 results from a follow-up national survey

A prior national survey of one in eight randomly selected general practices in England estimated that 39% of general practices [95% confidence interval (CI) 35-43%] provided some access to complementary or alternative medicine (CAM) therapies in 1995. A repeat survey, conducted in 2001, estimated that one in two practices in England now offer their patients some access to CAMs (95% CI 46-52%). The change was due to increased provision in-house; the proportion of practices making NHS referrals remained unchanged. The proportion of services supported by patient payments rose from 26 to 42%.     

中西医结合保守治疗输卵管妊娠临床分析

目的 探讨输卵管妊娠保守治疗方法及临床适应症,以维持输卵管的完整性和功能,增加生育机能.方法 对48例输卵管妊娠病例米非司酮加宫外孕1号方剂保守治疗的临床资料进行总结分析.结果 48例保守治疗成功38例,失败10例.保守治疗成功率为71.1%,各种类型的异位妊娠治疗需要的疗程明显不同,陈旧型平均3个疗程,流产型1.5个疗程,未破型2.3个疗程.结论 中西医结合治疗部分输卵管妊娠如陈旧型、未破型及流产型简单可行,成功率高,维持了输卵管的完整性,增加了生育机能.     

舟山群岛新区妊娠期糖尿病的临床特点和防治

目的：回顾性分析舟山群岛新区妊娠期糖尿病（ GDM）的临床特点和防治体会。方法搜集2013年1月至2014年12月舟山群岛新区GDM患者300例为研究对象，按照不同干预措施分为对照组（ n＝150）与观察组（ n＝150）。对照组给予常规的内科治疗，观察组在此基础上给予饮食干预及健康教育，随访两组患者的干预情况。结果观察组对GDM基础知识认知率、常见并发症知晓率和正常血糖值认知率均分别高于对照组，经比较差异均具有统计学意义（χ2值分别为57．960、75．505、100．259，均P＜0．05）。观察组饮食干预认知率、合理饮食率均分别高于对照组，经比较差异均具有统计学意义（χ2值分别为20．184、7．441，均P＜0．05）；观察组糖化血红蛋白水平为（4．9±1．3）％，低于对照组的（7．8±1．6）％，经比较差异具有统计学意义（t＝17．228，P＜0．05）。结论 GDM患者经营养门诊做出相应干预后，能有效提高对自身疾病的认识，树立健康新观念，促进对相关健康行为的执行。     

Attitudes of Arab and Jewish patients toward integration of complementary medicine in primary care clinics in Israel: a cross-cultural study

The purpose of this cross-cultural study was to evaluate patient perspectives on complementary and alternative medicine (CAM) integration within primary care clinics. It is one of the first multiethnic studies to explore patients' perspectives on the best model for integrating CAM into the conventional care setting. We developed a 13-item questionnaire that addresses issues of CAM use, expectations from the primary care physicians concerning CAM, and attitudes toward CAM integration within a patient's primary care clinic. We constructed the questionnaire with cross-cultural sensitivity concerning the core concepts of CAM and traditional medicine in both the Arab and Jewish communities in northern Israel. Data for statistical analysis were obtained from 3840 patients attending seven primary care clinics. Of the 3713 respondents who were willing to identify their religion, 2184 defined themselves as Muslims, Christians, or Druze and 1529 as Jews. Respondents in the two groups were equally distributed by sex but differed significantly by age, education, self-rated religiosity, and self-reported chronic diseases in their medical background. Respondents in the two groups reported comparable overall CAM use during the previous year, but the Arab respondents reported more use of herbs and traditional medicine. Respondents in both groups stated that their primary expectation from a family physician concerning CAM was to refer them appropriately and safely to a CAM practitioner. Respondents in both groups greatly supported a theoretical scenario of CAM integration into primary medical care. However, Arab respondents were more supportive of the option that non-physician CAM practitioners would provide CAM rather than physicians.     

Alzheimer's treatment in nursing homes: room for improvement

Managing Alzheimer's disease (AD) continues to challenge long-term care physicians and administrators. Although pharmacologic treatment can substantially benefit AD patients in the nursing home setting, common misconceptions and skepticism about its value are barriers to treatment use. Aggressive treatment for AD maximizes patient function and independence and is cost-effective. Herein we discuss state-of-the-art treatment of AD with a view to providing nursing home physicians a framework from which to make treatment decisions.     

Dealing with ceiling baseline treatment satisfaction level in patients with diabetes under flexible, functional insulin treatment: Assessment of improvements in treatment satisfaction with a new insulin analogue

Even a small improvement in satisfaction with treatment for a chronic disease can be valuable. However, sensitive measurements instruments are needed to assess the effects of treatment changes in patients already well satisfied with baseline treatment. Such instruments were thought to be necessary to deal with ceiling effects in scores of satisfaction with functional insulin treatment (FIT) accommodating full flexibility of food intake and lifestyle in diabetes by manipulation of insulin (FIT; Howorka etal. 2000). The Status(S) version of the Diabetes Treatment Satisfaction Questionnaire (DTSQ, Bradley 1994) was extended with items measuring specific components of FIT and its psychometric properties investigated in a validation study with 171 FIT patients with diabetes. A new Change(C) version of DTSQ extended for FIT was used together with the DTSQ(S) by 52 participants in a subsequent randomised cross-over study involving new fast-acting lispro vs. regular insulin, where treatment satisfaction was the primary outcome variable. Insulin lispro use improved satisfaction (p ≤ 0.001) both, on classical and extended versions of DTSQ(S) and (C), despite high baseline levels of satisfaction. However, the DTSQ(C) augmented the effects of lispro (p = 0.0001) apparent on DTSQ(S) scores and revealed significant treatment effects (p ≤ 0.01) not significant with DTSQ(S). In parallel, glycaemic control improved with lispro (e.g., HbA_1c, p = 0.023). Improved satisfaction with treatment was more apparent with DTSQ(C) than DTSQ(S) in patients who at baseline were at or near ceiling for treatment satisfaction. This revised version was published online in June 2006 with corrections to the Cover Date.     

Central diabetes insipidus associated with refeeding in anorexia nervosa: A case report

Anorexia nervosa (AN) has been associated with a multitude of hypothalamic pituitary abnormalities, although it is unknown which aberrations reflect disease causation and which are the consequences of severe malnutrition. Among these endocrinopathies, hypothalamic–posterior pituitary aberrations have been described, including disorders of osmoregulation. We report the case of an adolescent female with a history of severe AN, restricting subtype, treated aggressively with multiple hospitalizations. During hospitalization for severe weakness and lethargy, her course of medical stabilization was complicated by significant polyuria, ultimately diagnosed as central diabetes insipidus (DI). This is the first reported case, to our knowledge, of a severely malnourished adolescent with AN—restricting subtype developing central DI during the refeeding process for medical stabilization, thus adding to the small body of existing literature on disordered osmoregulation in this patient population. This case report raises the question as to whether the frequency of central DI during refeeding is greater than that previously recognized. Additional research should focus on how neuroendocrine dysregulation of water balance might impact the clinical course of AN and its treatment.