Complementary Practitioners Research Articles

A narrative review exploring the attitudes of nursing and complementary medicine students and practitioners toward biosciences curricula

ABSTRACT A foundational understanding of the biosciences underpins most undergraduate programmes of study that lead to a career in the healthcare professions. The study of bioscience subjects including anatomy, physiology, microbiology and biochemistry has been reported to be challenging for a subset of these students with many students reporting negative attitudes. Identifying the factors that drive attitudes of students and practitioners towards the study of biosciences could inform curriculum modifications to reduce the challenges experienced by students. A review of the literature was undertaken using the search terms ‘student attitudes’, ‘biosciences’, ‘nursing’, ‘complementary medicine’, and ‘student success’. The review includes peer-reviewed primary data articles published from 1996 to 2023. The search identified 26 articles that met the inclusion criteria with the majority of published research in the nursing field. The literature review identified three major themes underpinning the attitudes towards biosciences reported by nursing and complementary medicine students and practitioners: actual or perceived intellectual difficulty of the bioscience content, a perceived lack of relevance of the bioscience subjects to their programme of study, and previous experiences studying the sciences. Negative attitudes towards the study of the biosciences can reduce engagement, create anxiety, decrease motivation to learn, and ultimately affect academic performance of students. Through identifying, acknowledging and responding to perceived challenges with bioscience subjects, educators may be able to improve engagement, performance and ultimately student success and enhanced practitioner knowledge and skills.

Estimating Adverse Events Associated With Herbal Medicines Using Pharmacovigilance Databases: Systematic Review and Meta-Analysis.

Herbal medicines (HMs) are extensively used by consumers/patients worldwide. However, their safety profiles are often poorly reported and characterized. Previous studies have documented adverse events (AEs) associated with HMs, such as hepatotoxicity, renal failure, and allergic reactions. However, the prevalence rate of AEs related to HMs has been reported to be low. To date, no systematic review and meta-analysis has comprehensively analyzed the AEs of HMs using published data acquired from pharmacovigilance (PV) databases. This study aimed to (1) estimate the reporting rate of the AEs of HMs using PV databases and (2) assess the detailed data provided in AE reports. In this systematic review and meta-analysis, MEDLINE/PubMed, SCOPUS, EMBASE, and CINAHL were systematically searched for relevant studies (until December 2023). The DerSimonian-Laird random effects model was used for pooling the data, and subgroup analyses, the meta-regression model, and sensitivity analysis were used to explore the source of heterogeneity. Crombie's checklist was used to evaluate the risk of bias (ROB) of the included studies. In total, 26 studies met the eligibility criteria. The reporting rate of the AEs of HMs ranged considerably, from 0.03% to 29.84%, with a median overall pooled estimate of 1.42% (IQR 1.12%-1.72%). Subgroup analyses combined with the meta-regression model revealed that the reporting rate of the AEs of HMs was associated with the source of the reporter (P=.01). None of the included studies provided full details of suspected herbal products, only the main ingredients were disclosed, and other potentially harmful components were not listed. This systematic review and meta-analysis highlighted risks related to HMs, with a wide range of reporting rates, depending on the source of the reporter. Continuous efforts are necessary to standardize consumer reporting systems in terms of the reporting form, education, and follow-up strategy to improve data quality assurance, aiming to enhance the reliability and utility of PV data for monitoring the safety of HMs. Achieving effective monitoring and reporting of these AEs necessitates collaborative efforts from diverse stakeholders, including patients/consumers, manufacturers, physicians, complementary practitioners, sellers/distributors, and health authorities. PROSPERO (Prospective International Register of Systematic Reviews) CRD42021276492.

Integrative therapeutics for ocular surface disorders.

Integrative medicine techniques are increasingly accepted into the treatment paradigm for many chronic disorders including eye disease. Over 71% of patients, including 67% of those with eye disorders, use some form of Integrative therapy. Physicians should be well versed in evidence-based therapies to know how to refer patients for the best complimentary care. We highlight the most effective integrative therapeutics from different complementary treatment paradigms to offer a framework for approaching therapy in patients with ocular surface disorders (OSDs). Lifestyle and behavioral modifications help a proportion of people with OSDs like dry eye disease and allergic conjunctivitis, which are interrelated disorders. Nutrition and supplementation can also play a role in addressing underlying inflammation and improving OSD symptoms. Acupuncture and traditional herbal medicine may also benefit some patients. New technologies offer innovative treatment pathways in the treatment of OSD but require referral to Ocular Surface Treatment Centers. Integrative treatment approach for OSD incorporates allopathic medicine, traditional remedies and lifestyle behavioral interventions, Ayurveda and herbal medicine, Nutritional Supplements, Homeopathy, Acupuncture and Chinese Medicine. New cutting-edge technologies offer breakthroughs in difficult to treat ocular surface cases. Collaboration between allergy or otolaryngology offices, complementary practitioners, as well as optometrists and ophthalmologists in Ocular Surface Treatment Centers can offer patients new avenues of treatment.

What natural therapeutics are Australians using to relieve feelings of anxiousness?

IntroductionFeelings of anxiousness are experienced in the absence of diagnosed anxiety in Australia with prevalence and management of anxiousness not well understood within the population. Anxiety statistics represent the closest statistical comparison to anxiousness affecting 13 % of the Australian population. This figure is estimated to be much higher post pandemic based on global prevalence increasing. MethodsThe overall aim of this research is to identify natural ingestive and lifestyle therapeutics used by Australian adults to address their anxiousness. 115 provided consent. A cross sectional survey of the Australian adult population was conducted. The survey included enquiry about the impact of the COVID-19 pandemic, concomitant or isolated pharmaceutical use, demographic factors, potential barriers of access to natural therapeutics, types of practitioners commonly sought, exacerbating factors and manifestations of anxiousness. ResultsOne hundred and fifteen (n=115) respondents completed the survey. The survey allowed respondents to select more than one lifestyle option. The survey found that of the natural therapeutic options, 90.32 % (n=84) used lifestyle medicine (deep breathing, time in nature and meditation), 55.9 % (n=52) used herbal medicine (Passionflower, Lemon balm, Withania and St John’s wort) and 53.2 % (n=49) used nutrients (Magnesium, B Vitamins and Theanine and SAMe). The survey identified that complementary and alternative medicine (CAM) practitioners were the most common type of practitioner sought for information with naturopaths the preferred CAM practitioners. ConclusionNatural therapeutics as a strategy for managing anxiety has potential therapeutic application for Australian’s experiencing anxiousness, particularly post COVID-19 pandemic. Lifestyle medicine was the most common strategy utilized. There was a significant openness to trialing natural therapies.

Assessing the role and impact of research in clinical practice among acupuncturists in western countries: a multinational cross-sectional survey.

Evidence-informed practice is crucial to perform safe and efficient health interventions. In recent years, the evidence base of acupuncture continuously increased leading to the integration of acupuncture into clinical guidelines by various leading medical associations worldwide. At the same time, recent studies showed that licensed acupuncturists are rarely utilizing scientific research to inform their practice. This descriptive study using an online survey assessed the role of evidence-informed practice of acupuncturists in Austria, Germany, the United States of America, Australia, and New Zealand and aimed to determine critical factors relevant for promoting research literacy including demographical data, data about the clinical practice patterns, and the role and value of different information sources of traditional, complementary and integrative medicine (TCIM) practitioners. In total, 404 acupuncturists completed the online survey that included questions about demographic characteristics, the role and value of research in clinical practice, and details about the amount and type of continuing professional education. Univariate and multivariate analysis was used to determine significant predictors of the outcome variable "importance of research in clinical practice" (numerical rating scale, 0 to 100). The results showed that the majority of acupuncturists use certified courses as primary source of continuing professional education and value experts' opinions as the most reliable source of information. Multivariate analysis showed that the importance of research is dependent on the interest in research, an interdisciplinary learning environment, and positive experiences with research including if an acupuncture study ever changed the clinical practice of practitioners. Future educational programs should therefore focus on an interactive format aiming to promote skills to critically assess the value and practical use of research studies to improve the general practice of acupuncture.

Interprofessional contact with conventional healthcare providers in oncology: a survey among complementary medicine practitioners

BackgroundHalf of all patients with cancer use complementary medicine. Given the benefits and risks associated with complementary medicine use, contact between complementary medicine practitioners and conventional healthcare providers (oncologists, nurses) is important for monitoring the health and well-being of mutual patients with cancer. Research on occurrence of such interprofessional contact is scarce. This study aims to describe complementary medicine practitioners’ experiences with contact with conventional healthcare providers about mutual patients with cancer and the importance they attach to patient disclosure of complementary medicine use to their conventional healthcare provider. Predictors for interprofessional contact are explored.MethodsAn online survey was administered among complementary medicine practitioners who treat patients with cancer or cancer survivors and who are member of a professional association in the Netherlands.ResultsThe survey was completed by 1481 complementary medicine practitioners. 40% of the participants reported to have contact with conventional healthcare providers of patients with cancer. Only 13% of the complementary medicine practitioners experienced conventional healthcare providers as open to communication with them. An explorative logistic regression showed that openness of conventional healthcare providers as experienced by complementary medicine practitioners was the most important predictor for the occurrence of interprofessional contact (OR = 8.12, 95% CI 5.12–12.86, p < .001). Most complementary medicine practitioners (82%) considered it important that patients disclose complementary medicine use to their conventional healthcare provider and 49% of the participants always motivates their patients to do so.ConclusionsInterprofessional contact with conventional healthcare providers in oncology occurs but is not routine for most complementary medicine practitioners. More than one-third of the surveyed complementary medicine practitioners experienced conventional healthcare providers as not open to communication with them. The openness of conventional healthcare providers as experienced by complementary practitioners is an important predictor for interprofessional contact to take place. Most complementary practitioners acknowledge the importance of patient disclosure of complementary medicine use to their conventional healthcare provider. Open communication about the topic of complementary medicine use between complementary practitioners, conventional healthcare providers and patients prevents overlooking relevant medical information and facilitates optimal monitoring of health and safety of patients with cancer.

Prevalence and determinants of massage therapy use in the U.S.: Findings from the 2022 National Health Interview Survey

BackgroundThis study presents findings on the prevalence and determinants of past-year massage therapy use among U.S. adults from the 2022 round of the National Health Interview Survey (NHIS) (total available N = 27,651), an annual national population survey. MethodsThe NHIS uses face-to-face interviews on a representative sample of the civilian, noninstitutionalized U.S. population drawn using a systematic, stratified, single-stage probability design. The analyses consist of logistically modeling the determinants of three outcome (dependent) measures: past year utilization of a practitioner of massage, past year utilization of massage for pain, and past-year utilization of massage to restore overall health. Exposure (independent) variables include numerous sociodemographic, health services, health-related, mental health and well-being, and behavioral indicators. ResultsThe past-year prevalence rate for visiting a massage therapist in the U.S. is 11.1 %. The past-year rate for massage visits for pain is 6.0 %, and for restoring overall health is 8.5 %. Significantly higher rates are found among females and socioeconomically advantaged individuals, among other categories, and the strongest net determinant of massage therapy utilization is use of complementary or integrative practitioners. ConclusionIt is apparent that massage therapy is a commonly utilized therapeutic modality in the U.S. While use of complementary or integrative therapies is a significant determinant of massage utilization, it may not be fitting to consider massage therapy itself as an “alternative” therapy, but rather a widely used and increasingly mainstream therapeutic modality meriting wider integration into the community of healthcare professions.

Management of Polycystic Ovarian Syndrome: A Qualitative Inquiry among Complementary and Alternative Medicine Practitioners in South Africa.

Polycystic ovarian syndrome (PCOS) is a complex reproductive endocrinopathy affecting 4-20% of females of reproductive age. PCOS and its consequent complications such as infertility, diabetes mellitus and cardiovascular disease significantly impact clinical management. Complementary and alternative medicine (CAM), including homeopathy, is gaining recognition in PCOS management. There remains a paucity of formal protocols for managing PCOS within homeopathy and other CAM systems. This study aimed to explore and document existing therapeutic practices in the management of PCOS from diagnosis to treatment used by practitioners within various disciplines of CAM: viz., homeopathy, ayurveda, unani tibb, traditional Chinese medicine (TCM) and naturopathy, in the context of their unique philosophical background. In this explorative, descriptive study, data were collected from CAM practitioners in eThekwini Municipality, KwaZulu Natal, South Africa, using semi-structured interviews and analysed using Tesch's and Creswell's methods for qualitative analysis. Four themes emerged from the data, namely: CAM philosophical perspectives on PCOS, contributing factors, diagnosis of PCOS, and management of PCOS. Five sub-themes emerged: clinical diagnosis of PCOS, CAM-specific characterisation of PCOS, CAM-specific treatment of PCOS, adjunctive therapies, and lifestyle interventions. Homeopathic management comprised several prescribing methods, the most common ones being miasmatic/constitutional, keynote and clinical, alongside adjunctive therapies and lifestyle interventions. Other CAM modalities adopted similar holistic approaches. This paper offers a comprehensive exploration of the perceptions, clinical investigations and management practices in PCOS by homeopaths and four other CAM modalities - ayurveda, unani tibb, TCM and naturopathy - as documented in the study. Homeopaths and other CAM practitioners employed CAM-specific therapies, along with adjunctive therapies and lifestyle interventions, adopting holistic approaches. Enhancing the quality of life through emotional counselling, stress reduction and lifestyle improvements emerged as shared objectives across modalities. Our findings underscore the need to further explore inter-disciplinary collaboration in PCOS management among registered CAM practitioners, with the potential to expand the scope of comprehensive care for PCOS patients.

Development and evaluation of a manualised mental health awareness and stigma reduction intervention for Black faith communities: study protocol for the ON TRAC feasibility study

IntroductionThis paper presents the study protocol for a feasibility study of a manualised mental health awareness and stigma reduction intervention for Black faith communities, as part of the Outcomes and...

Complementary Care Collaboration: A Call to Action.

Collaboration among members of a client's/patient's wellness team is a key goal for effective service delivery, and yet often remains elusive. It is proposed that complementary health care practitioners are well situated to lead the way in collaboration. In this article, a framework for how practitioners in any discipline can begin to develop these professional collaborations is presented-NOTP! Network, openness, time, patience. It is a call to action.

Attitude and awareness of Indian parents from Kerala state towards children’s vaccination at the COVID-19 pandemic background

Background. Vaccination coverage of children in India is not sufficient since the COVID-19 pandemic (less than 90 %). This may lead to low adherence of parents to children’s vaccination.The aim. To study parental attitudes and awareness towards children vaccination programs in India at the COVID-19 pandemic background.Methods. Two hundred and fourteen participants from Kerala state (India) took part in the descriptive cross-sectional study via survey method. The survey was prepared with Google form according the principles of anonymity.Results. Indian parents demonstrated good adherence towards children’s vaccination, 98.6 % (95% confidence interval (CI): 95.9–99.5) of them vaccinated their child, and if vaccination appointment had to be rescheduled 84.6 % (95% CI: 79.1–88.8) of them vaccinated children after. Most of Indians (68.7 %; 95% CI: 62.1–74.5) preferred to vaccinate children in state clinics, however, 28.5 % (95% CI: 22.8–34.8) chose private clinics. Information about diseases that vaccines can prevent, vaccine safety, and side effects 47.2 % (95% CI: 40.6–53.8) of parents got from public pediatricians, 50.9 % (95% CI: 44.2–57.5) – from private pediatricians, and 10.3 % (95% CI: 6.8–15.0) – from complementary and alternative medicine practitioners. Over 80 % of Indians were informed about vaccination through mass media (83.6%; 95% CI: 78.1–87.9). Indian parents showed low awareness about vaccination, because 63.1 % (95% CI: 56.4–69.2) of parents wanted to know more about vaccination. Moreover, before vaccination 21.5 % (95% CI: 16.5–27.4) of them were not informed by a doctor about health benefits and possible risks for their children.Conclusion. In the COVID-19 pandemic Indian parents showed good attitude towards vaccination and low awareness in vaccination questions.

Mapping the clinical practice of traditional, complementary and integrative medicine in oncology in Western countries: A multinational cross-sectional survey

BackgroundMany cancer patients seek adjunctive therapies to biomedical cancer treatments at some point of their disease trajectory. While acupuncture is increasingly recommended by leading oncological associations, limited evidence exists concerning the evidence-informed practice and adherence to current guidelines of traditional complementary and integrative medicine (TCIM) practitioners treating cancer patients. MethodsAn international online-survey assessed the demographical data, clinical practice, and sources of information used by TCIM practitioners in Austria, Germany, United States of America, Australia, and New Zealand. ResultsIn total, 404 respondents completed the survey, of which 254 (62.9%) treated cancer patients. Most practitioners were acupuncturists and herbalists (57.1%), had (16.8 ± 9.9) years of clinical experience and see a median of 2 (1, 4) cancer patients per week. Breast cancer (61.8%) is the most common cancer type seen in TCIM clinics. Adjunctive TCIM treatments are frequently concurrent with the patient’s cancer specific treatment (39.9%), which is also reflected by the main goal of a TCIM treatment to alleviate side effects (52.4%). However, only 28.0% of the respondents are in contact with the treating oncologist. According to the respondents, pain is most effectively treated using acupuncture, while herbal medicine is best for cancer-related fatigue. TCIM practitioners mostly use certified courses (33.1%) or online databases (28.3%) but often believe that experts are more reliable to inform their practice (37.0%) than research publications (32.7%). ConclusionAcupuncturists and herbalists commonly treat cancer patients. Most practitioners use TCIM as an adjunct to biomedicine as supportive care and use it largely in accordance with current oncological guidelines. Please cite this article asHuemer M, Graca S, Bitsche S, Hofmann G, Armour M, Pichler M. Mapping the clinical practice of traditional, complementary and integrative medicine in oncology in Western countries: A multinational cross-sectional survey. J Integr Med. 2024; 22(1): 64–71.

Findings from Clinical, Historical, and Educational Research Conducted at the HOHM Foundation Office of Research

Background: This presentation provides an overview of the research work at HOHM Foundation and the most inspiring results from the last 5 years, highlighting important findings from our numerous published and ongoing research projects. Methods: HOHM Foundation officially launched its Office of Research (HOHM Research) in 2017 in keeping with the mission to enrich and support homeopathy, and an overarching aim to build infrastructure whereby rigorous outcomes-based research supports the deepening and expansion of the discipline of Homeopathy. Results: Recent peer-reviewed publications include five papers on the education of complementary and integrative medicine practitioners, as well as three observational case series of selected COVID-19 cases from the HHN Clinic. Additional papers based on the 5000+ dataset of acute cases from the Homeopathy Help Network (HHN) clinic are currently being prepared. From the Practitioner Generated Research Network (PGRN) – an organization promoting practice-based, patient-focused, practitioner-generated research that potentizes the profession of homeopathy and expands it into the larger scientific and integrative medical communities - a paper exploring attitudes to and uptake of repertory software in homeopathy clinical practice was published in Homeopathy in 2023. Current papers from the PGRN in the publication phase include an observational clinical case series using MYMOP 2017-20, and an observational clinical case series using MYCaW 2020-22 data, both collected from clients who attended the Academy of Homeopathy Education (AHE) chronic clinic. Other current research work focusses on artificial intelligence in Homeopathy, on the characteristics, demographics and perceptions of users of homeopathy in the US, the 2022 North American homeopathy education surveys, the 2023 North American workforce survey, and a clinical trial on Homeopathy in the management of Silicosis taking place in Brazil. Discussion: HOHM Research produces robust, relevant publications, and bring awareness of the effectiveness of homeopathy through real-world, outcomes-based research, focusing on clinical, historical, and educational research outputs.

Evidence for the role of multidisciplinary team care in people with pelvic pain and endometriosis: A systematic review.

Endometriosis is a chronic, inflammatory condition characterised by the presence of endometrial-like tissue outside the uterine cavity. Given the multi-system nature of the disease and the potential for significant negative impact on quality of life, there has been a long-standing recognition of the need for multidisciplinary care for people with endometriosis. However, there is paucity to the data supporting this approach, and much of the evidence is anecdotal. This systematic review aims to describe recent evidence-based models and patient-centred perspectives of multidisciplinary care for endometriosis, to improve understanding of the role of an integrated, multidisciplinary team in effectively addressing patients' care needs. PubMed, Medline, Embase and Web of Science were searched for relevant articles published between 1 January 2010 to 7 July 2022. Nineteen studies met the inclusion and exclusion criteria and pinpointed a multidisciplinary team consisting of gynaecologists, pain specialists, nurses, physiotherapists, psychologists, sex therapists, nutritionists, complementary medicine practitioners, and social workers to be most commonly utilised in holistically managing people with pelvic pain and endometriosis. Furthermore, patient perspectives on care highlighted the need for reliable information, respect and validation of experiences or preferences, discussion of long-term treatment plans and social and emotional supports. The trend for multidisciplinary team care for people with endometriosis is growing. Further consumer-driven clinical studies and outcome evaluations need to be conducted to determine the effect of multidisciplinary care on improvements to quality of life for people living with endometriosis and or pelvic pain.

What is integrative medicine? Establishing the decision criteria for an operational definition of integrative medicine for general practice health services research in Australia

BackgroundOperational definitions outline how a conceptual definition will be measured for consistent, reproducible data collection and analysis. This article reports the decision criteria that will be used for an operational definition of integrative medicine (IM) in a secondary analysis of an Australian national survey of general practitioner activity. MethodsA multidisciplinary team applied an iterative approach, informed by expert knowledge and literature reviews to establish decision criteria for categorizing the terms in the Australian clinical interface terminology of the International Classification of Primary Care, second edition (ICPC-2 PLUS) and the Coding Atlas for Pharmaceutical Substances, according to whether they reflected IM, conventional/mainstream medicine (MM), or both IM and MM (IM/MM). ResultsThe final decision criteria categorized all terms for examinations, investigations, advice/counselling, and drugs with synthetic ingredients, and terms for referrals to secondary care services and healthcare practitioners that are not a traditional or complementary medicine practitioner as MM. Terms that could apply to both styles of clinical practice (e.g., preventive health, lifestyle medicine, psychosocial and some drugs with natural ingredients) were categorised as IM/MM. The remaining terms, that mostly reflected the World Health Organization's theoretical definitions of traditional and complementary medicine, were categorized as IM. ConclusionDifferentiating between integrative and conventional/mainstream medicine in general practice is context specific and not always possible. The category IM/MM proposes integrative medicine as an extension, rather than an alternative. The rationale for the integrative medicine operational definition has relevance for researchers and health services in Australia, and internationally.

Building Bridges Toward Common Goals - A Call for Greater Collaboration Between Public Health and Integrative, Complementary and Traditional Health Providers.

This commentary makes the case for greater collaboration between public health professionals and integrative, complementary and traditional health practitioners (ICTHP). Previous partnerships have been successful, and more such collaborative work is needed to help overcome division, enhance the health workforce, and move all involved toward shared goals. ICTHP providers may be uniquely able to work across ideological differences and engage individuals and communities who are less trusting of public health, including those who are vaccine hesitant. Diverse partnerships can be difficult to maintain, but the application of equitable processes may aid their success. In the face of highly complex public health challenges, partnerships with ICTHP are critical.

Governing therapeutic pluralism: An environmental scan of the statutory regulation and government reimbursement of traditional and complementary medicine practitioners in the United States.

The World Health Organization has called on nation-states to statutorily govern, and integrate into state-funded healthcare systems, practitioners of traditional and complementary medicine (T&CM) (whose therapeutic approaches that fall outside the boundaries of conventional biomedicine). To date, however, there exist few rigorous reports of the degree to which individual nations have responded to this call. This study, an environmental scan, comprehensively documents the statutory governance and government reimbursement of T&CM practitioners in the United States (US). Across the US, where health practitioner governance falls within state and territorial (rather than federal) jurisdiction, over 300 laws have been enacted to statutorily regulate a wide range of T&CM practitioners. Nurse-midwives and chiropractors are universally licensed across all 56 US regulatory jurisdictions (50 states, 5 territories and the District of Columbia); other major T&CM practitioner groups are regulated in fewer jurisdictions (acupuncturists, n = 52; massage therapists, n = 50; direct-entry [non-nurse] midwives, n = 36; naturopaths, n = 24). Additional statutory stipulations exist to govern chiropractic assistants (n = 30), auricular (ear) acupuncture practitioners (n = 24), homeopathic practitioners (n = 3), and psychedelic facilitators (n = 1), as well as biomedical professionals who practice acupuncture and related techniques, e.g., 'dry needling' (n = 44). While professional entry requirements for licensed T&CM practitioners are substantially harmonized across jurisdictions, restricted titles and statutory scopes of practice vary. Ten states have furthermore implemented 'safe harbor' ('negative licensing') exemption laws enabling otherwise-unregulated T&CM practitioners to legally practice. Limited government reimbursement for T&CM care is available across several federal and state programs, including Medicare, Tricare, Veterans Health Authority, and Medicaid. Nurse-midwifery and chiropractic care is most frequently reimbursed; acupuncturists, naturopaths and massage therapists are eligible for much more limited coverage. Medicaid programs for low-income people in ten states furthermore cover the services of (unlicensed but statutorily-recognized) birth doulas. Additional research is needed to assess the impact of these regulations on US health care.

Intensification or diversification: responses by anti health-pass entrepreneurs to French government announcements.

We study the extent to which French entrepreneurs mobilized in an online collective action against the generalization of the health-pass policy in summer 2021. We document the dynamics of registrations on the website Animap.fr where entrepreneurs could claim they would not check the health-pass of their clients. We first note an over-representation of complementary and alternative medicine practitioners among the mobilized people. We also suggest that professionals related to the touristic industry mobilized on the website. Second, we show that the government announcements led to an increase in the mobilization. However, they did not affect the diversity of the entrepreneurs joining the action. This lack of diversity may have restricted the pool of potential participants as well as limited the identification of the "public opinion" to the mobilization.

Understanding how healthcare providers build consumer trust in the Australian food system: A qualitative study.

This study aimed to identify how dietitians and other healthcare providers work to build trust in food systems in the course of providing dietary education. Qualitative semi-structured interviews were conducted with 15 purposefully sampled dietitians (n = 5), general practitioners (n = 5), and complementary and alternative medicine practitioners (n = 5) within metropolitan South Australia. Interview data were then interpreted using an inductive thematic analysis approach, involving the construction of themes representing trust-enhancing roles around which beliefs about professional roles, the 'patient', and food and health were clustered. Healthcare providers communicate beliefs regarding (dis)trust in food systems through: (i) responding to patient queries and concerns following a food incident or scare; (ii) helping patients to identify (un)trustworthy elements of food supply systems; and (iii) encouraging consumption of locally produced and minimally processed food. Importantly, the expression of these roles differed according to participant beliefs about food and health (medico-scientific versus alternative medicine) and their adoption of professional projects that sought to promote medico-scientific ways of thinking about health and diet or manage the failures of Western medicine. The development and consolidation of trust-enhancing roles amongst healthcare providers likely requires disciplinary reflection on professional values and the processes by which practitioners apply these values to understanding food systems.

“If I'm a naturopath, It's because I trust nature above everything else”: Canadian naturopaths' construction of vaccination as a risk object

Canadians and Quebecers increasingly consult complementary and alternative medicine (CAM) practitioners in parallel with biomedical providers. The close relationship between vaccine hesitancy and CAM use remains under explored in Western countries. We present the results of a qualitative study conducted among one of Quebec's most used CAM approaches: naturopathy. Using Boholm and Corvellec's relational theory of risk to illustrate naturopaths' construction of vaccination as an “object of risk”, we describe how the health representations of 30 Quebec naturopath interviewees are associated with the ways they perceived the risks of infectious diseases and vaccination. Our findings illustrate how Quebec naturopaths' view the body as “at risk” from the possible harmful effects of vaccines. For these naturopaths, the body is a site, a “terrain”, where homeostasis must continually be preserved, and needs to be protected from risks such as vaccines—which were seen as far riskier than infectious diseases—through natural means. Such views are often perceived as unscientific or even irrational by public health researchers. Our study highlights that naturopaths' attitudes towards vaccination are perfectly aligned with the epistemological tenets of their risk representations and conceptions of health.