Complementary Medicine Products Research Articles

Complementary medicine products used in pregnancy and lactation and an examination of the information sources accessed pertaining to maternal health literacy: a systematic review of qualitative studies

BackgroundThe prevalence of complementary medicine use in pregnancy and lactation has been increasingly noted internationally. This systematic review aimed to determine the complementary medicine products (CMPs) used in pregnancy and/or lactation for the benefit of the mother, the pregnancy, child and/or the breastfeeding process. Additionally, it aimed to explore the resources women used, and to examine the role of maternal health literacy in this process.MethodsSeven databases were comprehensively searched to identify studies published in peer-reviewed journals (1995–2017). Relevant data were extracted and thematic analysis undertaken to identify key themes related to the review objectives.ResultsA total of 4574 articles were identified; 28 qualitative studies met the inclusion criteria. Quantitative studies were removed for a separate, concurrent review. Herbal medicines were the main CMPs identified (n = 21 papers) in the qualitative studies, with a smaller number examining vitamin and mineral supplements together with herbal medicines (n = 3), and micronutrient supplements (n = 3). Shared cultural knowledge and traditions, followed by women elders and health care professionals were the information sources most accessed by women when choosing to use CMPs. Women used CMPs for perceived physical, mental-emotional, spiritual and cultural benefits for their pregnancies, their own health, the health of their unborn or breastfeeding babies, and/or the breastfeeding process. Two over-arching motives were identified: 1) to protect themselves or their babies from adverse events; 2) to facilitate the normal physiological processes of pregnancy, birth and lactation. Decisions to use CMPs were made within the context of their own cultures, reflected in the locus of control regarding decision-making in pregnancy and lactation, and in the health literacy environment. Medical pluralism was very common and women navigated through and between different health care services and systems throughout their pregnancies and breastfeeding journeys.ConclusionsPregnant and breastfeeding women use herbal medicines and micronutrient supplements for a variety of perceived benefits to their babies’ and their own holistic health. Women access a range of CMP-related information sources with shared cultural knowledge and women elders the most frequently accessed sources, followed by HCPs. Culture influences maternal health literacy and thus women’s health care choices including CMP use.

Daily Consumption of the Capparis spinosa Reduces Some Atherogenic Indices in Patients with Non-alcoholic Fatty Liver Disease: A Randomized, Double-blind, Clinical Trial

Background: Despite a number of studies on the effects of complementary medicine products, the effects of caper fruit pickle (CFP), as Iranian traditional medicine (ITM), is not clear in non-alcoholic fatty liver disease (NAFLD). Objectives: The current study aimed at assessing the effect of the CFP on anthropometric measures and some atherogenic indices in patients with non-alcoholic fatty liver disease (NAFLD). Methods: A 12-week randomized, controlled, double-blind trial was conducted on 44 patients with NAFLD via block randomization method assigned to either the control (n = 22) or the CFP (n = 22) groups, from March to October 2016 in Zanjan city, Iran. The CFP group received 40 - 50 g of the CFP with daily meals. Before and after the treatment, anthropometric measures, serum lipoprotein ratios, and liver enzymes were assessed. Results: After 12 weeks, weight and waist circumference significantly decreased both in the CFP (P < 0.001) and control groups (P = 0.001 and P = 0.03), respectively. Adjusted to the baseline measures, the a mean difference of alanine aminotransferase (ALT) (P = 0.04), low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL.C/HDL.C) (P = 0.001), triglyceride/HDL.C (TG/HDL.C) (P < 0.001) and total cholesterol/HDL.C (TC/HDL.C) (P = 0.001) decreased more significantly in the CFP than the control group at the end of the study. Conclusions: The current study results suggested that daily consumption of the CFP for 12 weeks may potentially prevent cardiovascular complications in patients with NAFLD. Further studies are needed to confirm the findings.

Complementary medicine products: interpreting the evidence base.

Many patients use complementary medicine (CM) products, such as vitamins, minerals and herbs as part of self-care without professional advice or disclosure to their doctors. While use of CM products is gaining awareness by the medical community and there is mounting evidence for their safety, efficacy and cost-effectiveness, there is also the potential for adverse events from inappropriate use and/or withdrawal, as well as interactions with other medicines. Due to the unique and complex properties of many CM products, research evidence is specific to individual preparations and this can lead to confusion when assessing label claims and interpreting the results of clinical trials and systematic reviews. While the Australian regulatory environment for CM products is the same as for prescription medicines and is based on risk, there is a great need for consumers and clinicians to have access to easily understood, evidence-based information to facilitate informed decision-making.

Development of a strategic model for integrating complementary medicines into professional pharmacy practice.

Traditional medicine (TM) and complementary medicine (CM) products have played an increasingly important role in the business of pharmacy for over two decades in a number of countries. With a focus on the quality use of all medicines including complementary medicines, there have been a number of initiatives to encourage the integration of TM/CM products into professional practice. Recent studies report that many of the barriers that prevent such integration remain. To explore the pharmacists' perspective regarding how barriers to the integration of TM/CM products into the professional practice of pharmacy could be resolved. Purposive sampling and snowballing were used to recruit 11 registered pharmacists who had worked in community pharmacy for a minimum of 6 months to participate in one of 3 focus groups. Focus group questions informed by previous studies, explored participants' perspectives on the actions required to support professional services related to TM/CM products. Pharmacists proposed that five key stakeholders (professional pharmacy organizations, universities, government, pharmacy owners, and pharmacists) enact 4 developments that require a collaborative effort ("education and training", "building the evidence base", "developing reliable and accessible information resources", and "workplace support for best practice"). Manufacturers of TM/CM products were not identified by pharmacists as collaborators in these developments. Collectively, the findings from this study support a strategic model to guide the integration of TM/CM products into the professional practice of pharmacy.

Health literacy and the decision-making process to use complementary medicine products in pregnancy and lactation

Health literacy and the decision-making process to use complementary medicine products in pregnancy and lactation

Substantial out-of-pocket expenditure on maternity care practitioner consultations and treatments during pregnancy: estimates from a nationally-representative sample of pregnant women in Australia

BackgroundA wide range of health care options are utilised by pregnant women in Australia. The out-of-pocket costs of maternity care in Australia vary depending on many factors including model of care utilised, health insurance coverage, and women’s decision to access health services outside of conventional maternity care provision.MethodsWomen from the 1973–78 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH) who identified as pregnant or as recently having given birth in 2009 were invited to complete a sub-study questionnaire investigating health service utilisation during their most recent pregnancy.ResultsA total of 1,835 women agreed to participate in the sub-study. The majority of women (99.8%) consulted with a conventional health care practitioner during pregnancy, 49.4% consulted with a complementary and alternative medicine practitioner at least once during pregnancy and 89.6% of the women used a complementary and alternative medicine product. Women reported an average of AUD$781.10 in out-of-pocket expenses for consultations with conventional health care practitioners, AUD$185.40 in out-of-pocket expenses for consultations with complementary and alternative medicine practitioners and AUD$179.60 in out-of-pocket expenses for complementary and alternative medicine products. From the study data we estimate Australian pregnant women spend over AUD$337 M on out-of-pocket health services.ConclusionWhile the majority of pregnant women in Australia may obtain health services via the publically-funded health care system and/or private health insurance coverage, our analysis identifies substantial out-of-pocket expenditure for health care by pregnant women – a trend in public spending for maternity care of importance to policy makers, health administrators, and health professionals.

Self-Management of Stress with Complementary and Alternative Medicine: Factors That Influence and Inform Decision Making—A Systematic Review of the Literature

Background: Stress, sometimes referred to as psychological distress, is common in Australia and many people choose to self-medicate by purchasing over-the-counter complementary and alternative medicine (CAM) products from pharmacies. Aims: This review has five aims: to determine the philosophical underpinnings of CAM use in the general population and also in those who experience a mental health disorder, notably psychological distress; to find more specific reasons for CAM use in those two population groups; and to examine the influences and information sources relating to CAM purchases in pharmacy, particularly for stress. Materials and Methods: This review was conducted using a systematic approach across relevant databases and using specific inclusion criteria. Results: Examination of 47 studies produced a disparate group of findings. Consumers of CAM in the general population often related to the modality with a philosophical congruence (e.g., holistic views and personal empowerment) and more specifically the ability to actively and positively self-manage their health. Those with mental health disorders felt similarly, but also exhibited a negative attitude to conventional treatments, often considering CAM safer and more appropriate. A more specific reason for CAM adoption in the wider population was prior usage and self-belief of effectiveness. Only one study examined CAM use in those with a mental health disorder indicating a “last resort” attitude. In six studies, one being Australian, it was demonstrated that family and friends were common sources of influence and information; however, no studies were found relating to CAM usage in those with psychological distress. Conclusion: CAM use both in the general Australian population and in those self-managing stress is common. These groups share some philosophical viewpoints. Family and friends often guide decision making in the first group, but almost nothing is known of those suffering stress, indicating a dire need for research. Implications indicate an extended role for pharmacists and pharmacy staff in this area.

Complementary Medicine Use And Regulation – An Australian Perspective

A government funded survey of 1121 Australian pharmacy customers found 72% take over-the-counter complementary medicine products (CMs). They are used to relieve symptoms, prevent disease and enhance health [1]. The use of CMs does not reduce with age, only the pattern of use changes. The majority of CMs are purchased in community pharmacies where customers expect pharmacists to provide information about safety and efficacy; however, surveys show pharmacists are not confident and poorly-equipped to provide evidence-informed guidance. Naturopaths generally consult in clinics however there are now pharmacies employing naturopaths to provide customer advice.

Natural Products from Chinese Medicines with Potential Benefits to Bone Health.

Osteoporosis is a progressive, systemic bone disorder characterized by loss of bone mass and microstructure, leading to reduced bone strength and increased risk of fracture. It is often associated with reduced quality of life and other medical complications. The disease is common in the aging population, particularly among postmenopausal women and patients who receive long-term steroidal therapy. Given the rapid growth of the aging population, increasing life expectancy, the prevalence of bone loss, and financial burden to the healthcare system and individuals, demand for new therapeutic agents and nutritional supplements for the management and promotion of bone health is pressing. With the advent of global interest in complementary and alternative medicine and natural products, Chinese medicine serves as a viable source to offer benefits for the improvement and maintenance of bone health. This review summarizes the scientific information obtained from recent literatures on the chemical ingredients of Chinese medicinal plants that have been reported to possess osteoprotective and related properties in cell-based and/or animal models. Some of these natural products (or their derivatives) may become promising leads for development into dietary supplements or therapeutic drugs.

The use of complementary medicine in patients with diabetes

OBJECTIVE:Diabetes mellitus (DM) is a growing health problem with serious complications. The chronic and progressive nature of the disease often leads patients to use complementary and integrative medicine. The present study aimed to investigate the frequency of use of alternative medicine by patients with DM and the products used.METHODS:Between September 2014 and May 2015, 301 patients with DM were selected from Bezmialem Foundation University Hospital Diabetes Clinic to participate in the study.RESULTS:The results of the study indicate that 81 (26.9%) patients had tried alternative medicine, and 50 (16.6%) patients continued to use some form of alternative medicine product. A total of 43 (14.3%) patients used such products every day and 24 (8%) patients had used alternative medicine products for up to 6 months. Glycated hemoglobin (HbA1c) levels were significantly decreased in patients using alternative medicine products compared to the remainder of patients in the study (p=0.017). No other significant difference was found between the two groups. It was observed that among patients using alternative medicine products, only 10 (12%) had informed their physicians.CONCLUSION:This study indicated that patients with diabetes are very likely to use alternative medicine products. Additional studies are needed to further determine the efficacy of these products. Patients as well as health providers must be educated about complementary medicine and alternative products.

Ligustrum lucidum and its Constituents: A Mini-Review on the Anti-Osteoporosis Potential

Osteoporosis is a metabolic bone disorder commonly occurred in aging populations, particularly postmenopausal women and patients who undergo long-term steroid or anti-estrogen therapies. Given the rapid growth of the aging population, the prevalence of bone loss, and the huge medical and healthcare cost involved, demand for alternative approaches for the promotion of bone health is pressing. With the advent of global interest in complementary and alternative medicine and natural products, Chinese medicine serves as a viable source that offers benefits to improve and maintain bone health. This review summarizes the scientific information on the Chinese medicinal herb Ligustrum lucidum and its chemical components as potential therapy for osteoporosis.

Women's attitudes towards the use of complementary and alternative medicine products during pregnancy

The aim of this study was to analyse women's attitudes towards the use of complementary and alternative medicine (CAM) products during pregnancy. The study sample was obtained via the Australian Longitudinal Study on Women's Health or ALSWH. A response rate of 79.2% (n = 1,835) was attained. Women who use herbal medicines (34.5%, n = 588) view CAM as a preventative measure, are looking for something holistic and are concerned about evidence of clinical efficacy when considering the use of these products during pregnancy. Women who use aromatherapy (17.4%, n = 319) and homoeopathy (13.3%, n = 244) want more personal control over their body and are concerned more about their own personal experience of the efficacy of CAM than clinical evidence of efficacy. As CAM use in pregnancy appears to be increasingly commonplace, insights into women's attitudes towards CAM are valuable for maternity healthcare providers.

‘I’m managing myself’: how and why people use St John’s wort as a strategy to manage their mental health risk

In this article, we examine the choice to use a complementary and alternative medicine product (St John’s wort) for the management of mental health risk. We draw on data from a study in which we conducted in-depth, semi-structured interviews with 41 adults who self-reported depression, stress or anxiety, in Melbourne, Australia, in 2011. We identified three groups of users – regular St John’s wort users, whose use was continuous; irregular users, whose use was occasional; and non-users, who had stopped or were contemplating use. In each group, St John’s wort use centred around managing risk, taking control and self-management. Participants described a process of weighing up risks and benefits of different treatment options. They viewed St John’s wort as a less risky and/or safer option than antidepressants because they perceived it to be more natural, with fewer side effects. They saw their use of St John’s wort as a means of exercising personal control over mental health risks, for example, to alleviate or self-manage symptoms of depression. Their use of St John’s wort was also linked to perceptions of broader social risks including the stigma and shame of needing to use antidepressants. The findings deepen our understanding of notions of mental health risk by pointing to the importance of localised knowledge of risk in decision-making, and the ways in which perceptions of, and hence responses to, risk differ between groups.

The Impact of a Mandatory Immersion Curriculum in Integrative Medicine for Graduating Medical Students

Although many Americans utilize complementary and alternative medicine (CAM) services and products, few medical school curricula consistently provide instruction in counseling patients on the use of CAM or strategies for identifying credible evidence on the safety and effectiveness of CAM therapies. This is a mixed methods study. A sustainable, mandatory, half-day CAM immersion curriculum for graduating medical students is described. Student comfort talking with patients about CAM, their willingness to refer patients to a CAM provider, and adequacy of the CAM curriculum was assessed. Students who participated in this mandatory curriculum, rated the medical school curriculum in CAM as more adequate than students at other medical schools without a mandatory curriculum. Students' narrative comments indicate the curriculum impacts students knowledge about CAM, patient use of CAM, and personal practice with CAM in the future. The timing of the CAM curriculum near to graduation, students' personal exploration of several CAM modalities through immersion, and student interaction with community CAM providers are aspects of the curriculum that make the curriculum successful and memorable.

Population pharmacokinetic modeling of the Qishe pill in three major traditional Chinese medicine-defined constitutional types of healthy Chinese subjects: study protocol for a randomized controlled trial.

BackgroundHigh incidences of neck pain morbidity are challenging in various situations for populations based on their demographic, physiological and pathological characteristics. Chinese proprietary herbal medicines, as Complementary and Alternative Medicine (CAM) products, are usually developed from well-established and long-standing recipes formulated as tablets or capsules. However, good quantification and strict standardization are still needed for implementation of individualized therapies. The Qishe pill was developed and has been used clinically since 2009. The Qishe pill’s personalized medicine should be documented and administered to various patients according to the ancient TCM system, a classification of personalized constitution types, established to determine predisposition and prognosis to diseases as well as therapy and life-style administration. Therefore, we describe the population pharmacokinetic profile of the Qishe pill and compare its metabolic rate in the three major constitution types (Qi-Deficiency, Yin-Deficiency and Blood-Stasis) to address major challenges to individualized standardized TCM.Methods/DesignHealthy subjects (N = 108) selected based on constitutional types will be assessed, and standardized pharmacokinetic protocol will be used for assessing demographic, physiological, and pathological data. Laboratory biomarkers will be evaluated and blood samples collected for pharmacokinetics(PK) analysis and second-generation gene sequencing. In single-dose administrations, subjects in each constitutional type cohort (N = 36) will be randomly divided into three groups to receive different Qishe pill doses (3.75, 7.5 and 15 grams).Multiomics, including next generation sequencing, metabolomics, and proteomics, will complement the Qishe pill’s multilevel assessment, with cytochrome P450 genes as targets. In a comparison with the general population, a systematic population pharmacokinetic (PopPK) model for the Qishe pill will be established and verified.Trial registrationThis study is registered at ClinicalTrials.gov, NCT02294448.15 November 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0568-6) contains supplementary material, which is available to authorized users.

Homeopathy and integrative medicine: keeping an open mind.

Some physicians have incorporated some forms of complementary and alternative medicine (CAM) or related medicinal products in their clinical practices, suggesting that an unconventional treatment approach might be seen as an integration rather than as an alternative to standard medical practice. Among the various CAMs, homeopathy enjoys growing popularity with the lay population, but it is not acknowledged by academia or included in medical guidelines. The major problem is to establish the effectiveness of this clinical approach using the strict criteria of evidence-based medicine. This issue of the Journal of Medicine and the Person collects contributions from some of the most prestigious centers and research groups working in the field of homeopathy and integrative medicine. These contributions are not specialized information but are of general interest, focusing on this discipline as one of the emerging fields of personalized medical treatment.

The effect of traffic lights and regulatory statements on the choice between complementary and conventional medicines in Australia: Results from a discrete choice experiment

It has been suggested that complementary medicines are currently ‘under-regulated’ in some countries due to their potential for harm as a direct result from side-effects or interactions; from delaying more effective care; or from the economic cost of purchasing an ineffective or inappropriate treatment. The requirement of additional labelling on complementary medicine products has been suggested in Australia and may provide additional information to consumers at the point of purchase. This paper details a unique way of testing the potential effects on consumer behaviour of including either a traffic light logo or regulatory statement on labels. Using a discrete choice experiment, data were collected in 2012 in a sample of 521 Australians with either type 2 diabetes or cardiovascular disease. We find that additional labelling can affect consumer behaviour, but in unpredictable ways. The results of this experiment are informative to further the dialogue concerning possible regulatory mechanisms.

Siphonochilus aethiopicus, a novel herbal ingredient for the management of asthma and allergies

CSIR Biosciences interactions with traditional health practitioners led to the identification of a plant, Siphonochilus aethiopicus, commonly known as African ginger. It is one of the most widely used medicinal plants in South Africa, for managing allergic diseases such as colds, influenza and sinus problems. Scientific research conducted, demonstrated the beneficial properties of the plant extract and led to the discovery of the active ingredient, a non-steroidal compound. The plant extract and/or the purified non-steroidal metabolite showed activity in the glucocorticoid receptor, histamine receptor and nuclear factor-κB binding assays as well as the phosphodiesterase IV and 5-lipoxygenase enzymatic assays [2]. All these systems play a crucial role in allergic diseases and inflammation.The organic extract of the rhizomes of the plant demonstrated reduced infiltration of inflammatory cells in the lung tissue of animals in an in vivo anti-asthmatic ovalbumin-sensitized mice assay. These effects were comparable to dexamethasone, a corticosteroid commonly used in clinical practice [2]. The organic extracts given orally to rats, did not show any evident signs of toxicity at the test concentrations of 300 – 2000 mg/kg. Collectively, all the pre-clinical results demonstrated the beneficial properties of the plant extract in the improvement of the symptomatology associated with allergic and infectious diseases and provides scientific evidence substantiating its traditional use and inclusion in complementary medicine products. The CSIR was granted a PCT for use of the extract and compound [1] (PCT/IB2007/050649). Different areas in South Africa have already been identified as ideal sites where cultivation programmes have been initiated for the plant species. As there is currently no clinical evidence of its safety and efficacy, the CSIR obtained approval by the Medical Control Council in South Africa to conduct a Phase IA Clinical, Tolerability study this year.

Complementary and alternative medicine: a survey of its use in pediatric cardiology.

The use of complementary and alternative medicine is high among children and youth with chronic illnesses, including patients with cardiac conditions. Our goal was to assess the prevalence and patterns of such use among patients presenting to academic pediatric cardiology clinics in Canada. A survey instrument was developed to inquire about current or previous use of complementary and alternative medicine products and practices, including indications, beliefs, sources of information and whether this use was discussed with physicians. Between February and July 2007, the survey was administered to patients (or their parents/guardians) presenting to 2 hospital-based cardiology clinics: the Stollery Children's Hospital in Edmonton, Alberta, and the Children's Hospital of Eastern Ontario in Ottawa, Ontario. At the Stollery Children's Hospital, 64.1% of the 145 respondents had used complementary and alternative medicine compared with 35.5% of the 31 respondents at the Children's Hospital of Eastern Ontario (p = 0.003). Overall, the most common products in current use were multivitamins (70.6%), vitamin C (22.1%), calcium (13.2%), unspecified "cold remedies" (11.8%) and fish oil or omega-3 fatty acids (11.8%). The most common practices in current use were massage (37.5%), faith healing (25.0%), chiropractic (20.0%), aromatherapy (15.0%) and Aboriginal healing (7.5%). Many patients (44.9%) used complementary and alternative medicine products at the same time as conventional prescription drugs. Concurrent use was discussed with physicians or pharmacists by 64.3% and 31.3% of respondents, respectively. Use of complementary and alternative medicine products and practices was high among patients seen in the pediatric cardiology clinics in our study. Most respondents believed that the use of these products and practices was helpful; few reported harms and many did not discuss this use with their physicians, increasing the potential for interactions with prescribed medications.

Understanding CAM Natural Health Products: Implications of Use Among Cancer Patients and Survivors.

Herbs, vitamins, and other natural health products are being used by cancer patients and survivors with increasing prevalence in the United States. These complementary and alternative medicine (CAM) products, which are also referred to as natural health products in Canada and abroad, are used during cancer treatment and the survivorship period to ease the burden of symptoms such as pain, fatigue, insomnia, anxiety, and depression and hence improve overall quality of life. Data indicate that while patients choose these products for self-treatment, they often do not inform their health-care providers, thereby presenting the potential for negative interactions. This article gives an overview of CAM natural health products, including discussion of herbs, vitamins, and other supplements such as minerals, enzymes, and more. Related research is presented, and implications for advanced practitioners are discussed. Insights into guiding safe and effective use among patients as well as appropriate decision-making strategies are explored.