The development of a survey instrument to measure the barriers to the conduct and application of research in complementary and alternative medicine: a Delphi study

Background

As Complementary and Alternative medicine (CAM) grows in popularity, there is overt recognition for research evidence to inform clinical practice. While various strategies have been trialed to overcome the barriers to such progress, it is important to first understand the extent to which these barriers impact the conduct and application of CAM research. This study aimed to garner consensus and agreement among CAM researchers and practitioners in refining and validating a preliminary survey instrument for measuring these barriers.

Methods

A three-round Delphi study was undertaken with 22 international experts of CAM research and practice. Round one gathered consensus on 30 statements listing barriers to the application and conduct of CAM research. Only rounds two and three sought consensus on revised statements. Any statement demonstrating ≥?70% agreement on a four-point Likert scale was determined to have reached consensus.

Results

Consensus and agreement was achieved for all 30 statements listing the barriers to the application and conduct of research in CAM. Additional commentary by the Delphi participants directed whether a statement had to be split into two parts or reworded. This process resulted in the generation of the “BarrierS To the Application and Conduct of rEsearch” (oBSTACLES) instrument.

Conclusion

This study, the first of its kind on this topic, identified consensus and agreement on a series of evidence-informed statements to measure the barriers to the conduct and application of research in CAM. The uniqueness of the oBSTACLES instrument is its ability to measure barriers across the evidence-based continuum.

     

Sexual behavior and condom practices among Los Angeles women.

BACKGROUND: The sociodemographic correlates of the number of recent sexual partners and condom use are investigated in a population-based sample of 1,178 unmarried women living in Los Angeles County. RESULTS: Asian Americans, foreign born, and older women are less likely to be sexually active and that more educated and previously married women are more likely. Among the sexually active (n = 909), Hispanic women and older women are less likely to have multiple partners, and younger and previously married women more are more likely. African-American women and younger women are more likely to use condoms; older and previously married women are less likely. CONCLUSIONS: Results from this study indicate that women-centered primary and secondary prevention efforts may benefit from targeting women not previously considered, such as women of post-reproductive age and divorced women.     

Cerivastatin and atorvastatin inhibit IL-3-dependent differentiation and IgE-mediated histamine release in human basophils and downmodulate expression of the basophil-activation antigen CD203c/E-NPP3

Recent data suggest that the statins, apart from their lipid-lowering activity, exhibit profound anti-inflammatory effects. Basophils are major proinflammatory effector cells in diverse pathologic reactions. We have examined the in vitro effects of five different statins on primary human basophils, their progenitors, and the basophil cell line KU-812. Preincubation of blood basophils with cerivastatin or atorvastatin (0.1-100 microM) for 24 h reduced their capacity to release histamine on immunoglobulin E (IgE)-dependent stimulation in a dose-dependent manner. These statins also inhibited IgE-dependent up-regulation of the basophil-activation antigen CD203c. Moreover, both statins suppressed interleukin-3-induced differentiation of basophils from their progenitors as well as (3)H-thymidine uptake in KU-812 cells. All inhibitory effects of cerivastatin and atorvastatin were reversed by mevalonic acid (200 microM). The other statins tested (lovastatin, simvastatin, pravastatin) did not show significant inhibitory effects on basophils. Together, these data identify cerivastatin and atorvastatin as novel inhibitors of growth and activation of human basophils.     

Predictors of Daily Pain Medication Use in Individuals with Recurrent Back Pain

Purpose

A key component to chronic pain management regimens is the use of analgesic medications. Psychological factors, such as mood states, may also affect the use of pain medications for individuals with chronic pain, but few observational studies have examined how these factors may predict pain medication use at the daily level.

Methods

Daily assessments from 104 individuals with back pain were used to examine fluctuations in daily pain intensity, mood, sleep quality, and physical activity as predictors of the likelihood of pain medication (opioid and non-opioid) use and levels of medication use on the same day.

Results

Pain intensity and mood ratings significantly predicted whether participants used pain medication on the same day, while only pain intensity predicted whether participants used more medication than usual. Further, current opioid users were more likely to increase the amount of their medication use on days of higher pain.

Discussion

This article identifies fluctuations in daily pain intensity and mood as salient predictors of daily pain medication use in individuals with recurrent back pain. The current study is among the first to highlight both pain and mood states as predictors of daily pain medication use in individuals with back pain, though future studies may expand on these findings through the use of higher-resolution daily medication use variables.

     

Effects of vitamin D in lung, stomach, esophagus and testis tissues following administration of urethane in balb/c mice

OBJECTIVE: To elucidate the role of vitamin D in the histopathological alterations process and K-ras gene mutation exon 1 of tissues including lung, stomach, esophagus, and testis, by the administration of urethane. METHODS: An experimental study in inbred balb/c mice aged 9-11 weeks was designed. This investigation was performed from 2003 to 2005 in the Department of Medical Genetics, Medical Sciences/University of Tehran, Tehran, Iran. The samples were classified into 3 groups: the urethane group was characterized by intraperitoneal injection of 3 times urethane (600 mg/kg/day at 48 hour intervals). The second group U+D was given 3.5 mg/kg (6.3 mg/1000 ml) vitamin D in the drinking water for 4 weeks following the same intake of urethane as the first group, and the third one was the control group. All mice were sacrificed after 20 weeks, tissues were removed and examined for histopathological changes and mutations in the exon 1 of the K-ras gene. RESULTS: Thirty mice were studied. The formation of lung tumor was, significantly, increased in the urethane group as compared with the control group (p<0.005), however, such a difference was not found in the U+D and control groups. In addition, there was no significant difference between all groups in other examined tissues. There was no mutation in the exon 1 of K-ras gene of the lung adenomas, adenocarcinomas, and stomach metaplasia. CONCLUSION: Our results showed the anti-tumorigenic effect of vitamin D3 in lung tumors induced by urethane. Vitamin D may reduce the risks of a tumorigenic diet that includes high fermented foods and beverages that produce urethane in their process.     

Drug-induced cutaneous pseudolymphoma: A systematic review of the literature

Drug-induced cutaneous pseudolymphoma (CPL) is a common form of pseudolymphoma and there are numerous drugs associated with it. In this study, we performed a systematic review of the literature by searching PubMed/Medline and Embase databases to determine the most common drugs responsible for CPL and to define the demographic, clinical, histopathological and immunopathological characteristics of patients (updated on 30 December 2020). From 883 initially found articles, 56 studies (89 reported cases) were included. The mean age of patients was 54.4 ± 17.7 (ranging 8–86) years, and 46 (51.7%) were men. The median time interval between drug intake and CPL occurrence was 120 days (range 1–7300 days). The shortest median time interval between taking the drug and the onset of the disease was observed among patients taking antidepressants (60 days) (range 7–540) and the longest median time interval was observed in individuals using immunomodulators (300 days) (range 3–7300). The most-reported drug categories causing CPL were anti-hypertensives (17.9%), anticonvulsants (14.6%), monoclonal antibodies (13.4%) and antidepressants (11.2%). Moreover, the most common drugs were phenytoin (6.7%), amlodipine (5.6%), fluoxetine (5.6%) and carbamazepine (4.4%). Histopathological evaluation of 76 cases revealed 62 (81.5%) reports of T-cell infiltrations. Furthermore, positive reports of CD4 (94.0%), CD8 (93.0%) and CD30 (87.5%) were noted. The lowest prevalence of CD30-positive reports was observed among monoclonal antibodies. In conclusion, anti-hypertensives, anti-convulsants, monoclonal antibodies and anti-depressants are the most common drugs responsible for CPL. It mostly presents in middle-aged patients with almost no gender difference as pruritic papules, nodules and plaques.     

The association between patellofemoral alignment and osteoarthritis in magnetic resonance imaging

ObjectivesOsteoarthritis (OA) is the most common joint disease in the world, becoming more prevalent with increasing age, and causes a significant burden on individuals and society. So far, several factors have been identified in association with OA of the knee joint. Age is the most crucial uncontrollable risk factor for OA. There are conflicting results regarding the relationship between patellofemoral joint orientation and OA. This study aims to elucidate the relationship between patellofemoral joint alignment and OA evidence.Material and methodsA total of 277 MRIs performed at Imam Reza Hospital during the first half of 2017 were included. Patients were divided into two groups, under 50 years old and over 50 years old. Femoral sulcus angle (SA) and depth (SD), lateral patellar displacement (LPD), tibial tubercle-trochlear groove (TTTG), lateral patellofemoral angle (LPFA), and Insall-Salvati index were measured in axial and sagittal images. The morphology of the patellofemoral articular cartilage was evaluated and the grade of joint damage was determined. P-value < 0.05 was considered as significant.ResultsSignificant correlations between SA (p-value = 0.01), SD (p-value < 0.001), Insall-Salvati index (p-value < 0.001), LPD (p-value = 0.02) values and OA in patients less than 50 years old were observed. A weak correlation was observed between SD and Insall-Salvati index values with increasing grade of articular cartilage damage (r = 0.21 and r = 0.21, respectively).ConclusionsPatellofemoral joint asymmetry in the younger people was significantly associated with joint cartilage damage and premature patellofemoral joint OA. Joint misalignment by stressing the articular cartilage causes joint cartilage changes that may be congenital or due to bone injuries such as trauma and surgery.