Complementary Practitioners Research Articles

Strategies to integrate community-based traditional and complementary healthcare systems into mainstream HIV prevention programs in resource-limited settings

BackgroundGlobal spending for HIV prevention has been decreasing over the years. As a result, several low-income countries, including Nepal, are increasingly facing the challenge to minimize the funding gap to continue providing HIV prevention services to the people. In this paper, we have attempted to clarify why it is important to integrate community-based traditional and complementary healthcare systems and mobilize them into the mainstream HIV programs to ensure access to HIV prevention messages, HIV testing, and treatment in resource-limited settings.Main bodyFirst, we argue that the traditional and complementary healthcare practitioners can be mobilized to routinely provide HIV prevention messages to their clients, and, next, some of them can be trained to build their capacity to work as counselors or educators for HIV prevention in the community.ConclusionThese approaches, if implemented, can help continue HIV prevention initiatives and contain the HIV epidemic at the local level in the rural communities with limited cost and resources.

Identification of the conditions that complementary medicine practitioners recommend gluten free diets for in Australia

IntroductionA gluten free diet (GFD) is indicated for the medical management of coeliac disease as well as gluten ataxia, dermatitis herpetiformis, and wheat allergy. Complementary medicine practitioners (CMPs) recommend removing gluten from the diet, but it is not known what symptoms or conditions they recommend gluten free diets for. The aim of this study is to describe for what conditions Australian naturopaths, Western herbalists and nutritionists (non-dietetic) recommend a gluten free diet. MethodsThis was a sub-group analysis nested within a cross-sectional survey of practitioners recruited through the PRACI practice-based research network and relevant professional associations. A 40-item survey collected information on sociodemographic characteristics, practice and professional characteristics and specific questions on gluten related disorders between February and August 2017. Data was described using frequencies and percentages along with one-way ANOVA to determine group differences. ResultsOne hundred and forty-five complementary practitioners responded to the survey. The gastrointestinal conditions most frequently prescribed a GFD for were non-coeliac gluten sensitivity (99%), medically diagnosed coeliac disease (95.2%), inflammatory bowel disease (73.1%) and irritable bowel syndrome (60%). The most frequently prescribed GFDs for extra-intestinal conditions were skin conditions (60%), children with developmental disorders (53.1%), mental health conditions (46.2%) and weight management. DiscussionResults suggest that given the broad application of GFDs by CMPs, there may be therapeutic benefits for conditions other than known gluten related disorders. However, in the absence of appropriate investigations for gluten related disorders, the recommendation and positive response to a GFD may be inadvertently treating an undiagnosed gluten related disorder. In addition, a GFD may also be inadvertently managing other unknown intolerances that require different clinical management. ConclusionThis research highlights the need for further investigation into the potential benefits resulting from prescribing GFDs for conditions where there is no established evidence for the exclusion of dietary gluten.

The potential downstream effects of proposed changes in Australian private health insurance policy: The case for naturopathy

The Australian government has recently announced major reforms to the private health insurance (PHI) system. Amongst the changes are the removal of government-subsidised PHI rebates for consultations with most unregistered complementary medicine practitioners, including naturopathy. However, there are several doubts about these reforms, as this commentary explains, which primarily relate to (1) the basis of the decision, and (2) the consequences of the proposed changes. In terms of the former, an insufficient clinical evidence base was claimed to be the main driver of this decision. However, the evidence informing this decision had several limitations, and in the case of naturopathy, was somewhat contradictory. The absence of enforceable standards (from statutory registration) was another factor contributing to the decision; yet, for naturopathy, this has largely been the product of government inaction, rather than a lack of action from the profession. In terms of the downstream effects of these reforms, these could be considerable, including mass membership withdrawal from ancillary (extras) cover and cost-shifting to the public health sector; potentially leading to a rise in PHI premiums, increased demand for general practice services, and a rise in the number of avoidable hospitalisations. The proposed changes also deviate from international standards and declarations, and contravene key performance indicators of a quality health care system. In light of these concerns, the commentary calls for an immediate rethink of the intended PHI reforms, at least for naturopathy.

Statutory Regulation of Traditional Medicine Practitioners and Practices: The Need for Distinct Policy Making Guidelines.

The World Health Organization (WHO) has called for the increased statutory regulation of traditional and complementary medicine practitioners and practices, currently implemented in about half of nations surveyed. According to recent WHO data, however, the absence of policy guidelines in this area represents a significant barrier to implementation of such professional regulations. This commentary reviews several key challenges that distinguish the statutory regulation of traditional medicine practitioners and practices from biomedical professional regulation, providing a foundation for the development of policy making parameters in this area. Foremost in this regard are the ongoing impacts of the European colonial encounter, which reinforce biomedicine's disproportionate political dominance across the globe despite traditional medicine's ongoing widespread use (particularly in the global South). In this light, the authors discuss the conceptual and historical underpinnings of contemporary professional regulatory structures, the tensions between institutional and informal traditional medicine training pathways, and the policy challenges presented by the prospect of standardizing internally diverse indigenous healing approaches. Epistemic and evidentiary tensions, as well as the policy complexities surrounding the intersection of cultural and clinical considerations, present additional challenges to regulators. Conceptualizing professional regulation as an intellectual property claim under the law, the authors further consider what it means to protect traditional knowledge and prevent misappropriation in this context. Overall, the authors propose that innovative professional regulatory approaches are needed in this area to address safety, quality of care, and accessibility as key public interest concerns, while prioritizing the redress of historical inequities, protection of diverse indigenous knowledges, and delivery of care to underserved populations.

The diagnostic and clinical management of individuals recommended gluten free diets by complementary medicine practitioners

ObjectivesExcluding gluten containing foods from the diet is medically indicated for the management of coeliac disease, wheat allergy, gluten ataxia, non-coeliac gluten sensitivity, and dermatitis herpetiformis. However, the number of people following a gluten free diet (GF diet) far exceeds the number of people with an indication for such dietary restriction. It has been suggested that 70% of individuals who are recommended GF diets by complementary medicine practitioners have not had coeliac disease adequately excluded. The aim of this study was to describe the diagnostic and clinical management practices of naturopaths, Western herbalists and nutritionists (non-dietetic) associated with recommending GF diets. Design, subjects and outcome measuresA cross-sectional 40-item questionnaire was developed and administered online to 145 Australian naturopaths, nutritionists (non-dietetic) or Western herbal medicine practitioners via professional associations and a practice based network (PRACI) between February and April 2017. Demographic data and practice information related to recommending GF diets was collected. ResultsA total of 56.5% (82/145) practitioners reported that in the majority of cases they did not undertake any recommended diagnostic process, and 48% (71/145) of practitioners referred to a general practitioner to exclude medical conditions related to gluten ingestion prior to recommending a GF diet. A total of 10% (15/145) ordered coeliac serology through local laboratories, and 17% (24/145) through functional pathology companies. Non-coeliac gluten sensitivity was diagnosed by 56% (82/145) through an elimination and reintroduction diet, and 61% (88/145) used a diet and symptom diary. IgG antibody tests were used by 23% (33/145) of practitioners, and 5% (7/145) used kinesiology prior to recommending a GF diet. ConclusionClinical guidelines for the diagnosis of gluten related disorders are not followed by a substantial number of complementary medicine practitioners prior to recommending a GF diet. Strategies are required to improve the standard of practice in this area.

Registered Nurses’ communication about patients’ use of complementary therapies: A national survey

ObjectiveTo identify communication patterns of Registered Nurses regarding patients’ use of complementary therapies. MethodsA cross-sectional online survey conducted in 2017 recruited Australian Registered Nurses working in any area of nursing. ResultsResponses of 614 Registered Nurses were analysed. Patient-initiated discussion of complementary therapies were common for 77% of nurses; nurse-initiated discussions were perceived by 73% (sometimes/almost always/always). Nurses’ personal use of complementary therapies predicted discussion with patients and education-based, oncology, or aged care/rehabilitation nurses were most likely to initiate dialogue. Many (55%) did not ‘recommend’ a particular therapy, although 12% ‘almost always/always’ did so. Four out of five nurses (84%) documented patients’ use and communicated with medical/nursing colleagues about this use. Conversely, 61% ‘never’ or ‘almost never’ communicated with a complementary therapy practitioner. ConclusionNurses working in Australia often discuss complementary therapies, however they rarely specifically recommend their use. Their workplace environment and clinical context influenced nurses’ willingness to communicate about complementary therapy use. Practice implications evidencesuggests the need for policy development to promote communication between mainstream healthcare providers and complementary therapy practitioners to support the delivery of safe, high quality patient care.

Investigation into complementary and integrative medicine practitioners' clinical experience of intestinal permeability: A cross-sectional survey

BackgroundThis study aims to explore the conditions complementary and integrative medicine (CIM) practitioners associate with increased intestinal permeability (IP) and the methods they employ to assess IP. MethodsA cross-sectional survey of naturopaths, nutritionists and Western herbal medicine practitioners was undertaken (n = 227) through the Practitioner Research and Collaboration Initiative (PRACI) network. ResultsCIM practitioners (n = 36, response rate 15.9%) associate IP with gastrointestinal (100.0%), autoimmune (91.7%), skin (91.7%), neurological (80.6%), respiratory (55.6%) and liver-related conditions (44.4%). CIM practitioners frequently treat IP (72.7%); observing a minimum 3 months of treatment is required to resolve IP. Patient's signs and symptoms were the main reasons CIM practitioners suspected IP (94.1%). ConclusionCIM practitioners observe a clinical link between IP and a wide range of conditions, including those not yet recognised within the literature. The clinical experience of CIM practitioners holds substantial value to the advancement of research and the clinical management of IP.

Exploiting science? A systematic analysis of complementary and alternative medicine clinic websites’ marketing of stem cell therapies

ObjectiveTo identify the frequency and qualitative characteristics of stem cell-related marketing claims made on websites of clinics featuring common types of complementary and alternative medicine practitioners. The involvement of complementary...

How are complementary health professions regulated in Australia? An examination of complementary health professions in the national registration and accreditation scheme

ObjectivesThis study aims to provide an empirical examination of how complementary medicine practice in Australia is actually regulated under the current national registration model. MethodsData was obtained from Australian Health Practitioner Regulation Agency (AHPRA) Annual Reports for the years 2011/12–2014/15 and supplemented by the Chinese Medical Registration Board of Victoria (CMRBV) Annual Reports in 2011/12 for Chinese Medicine complaints. The data analysed includes complaint statistics, stage of closure of complaints and the outcome of complaints concerning Chinese medicine, chiropractic and osteopathy under the National Law. ResultsDuring 2014–2015 the number of complaints per 100 registrants for was highest for the medical board (4.4), while much lower for the chiropractic (1.5), osteopath (0.7) and Chinese medicine (0.5) boards. For conventional boards, 58% of complaints were closed at the assessment stage, while 57%, 29% and 16% of complaints to the osteopath, Chinese medicine and chiropractic boards respectively were closed at the assessment stage. The decision to suspend or cancel registration of health professionals was 17% from the Chinese medicine board, 14% from the Osteopathy Board, 1.5% from the chiropractor board and 0.6% from the medical board. ConclusionIt appears that complementary medicine practitioner regulation works at least as well as conventional regulation, and at most complementary medicine boards take a stricter interpretation of misconduct though more research would need to be undertaken to state this definitively. Our findings indicate that the public are using the statutory complaint mechanisms available to them with respect to the three CM groups.

The associations between medical, allied and complementary medicine practitioner visits and childhood vaccine uptake

BackgroundVaccination rates have remained steady for a number of years in Australia, however geographical areas of lower vaccine coverage remains a day-to-day challenge. The study explores parental attitudes, beliefs and intentions in relation to vaccination and examines the early effects of recent No Jab No Pay legislation. MethodsA national survey of was conducted, using an online questionnaire. Parents from all states in Australia with at least one child aged <6 years were invited to participate. ResultsA total of 429 parents participated in the study. The substantial majority of participants reported having their youngest child's vaccination status up to date (n = 401, 93.5%). A child’s vaccinations were more likely to be up to date if they had consulted a paediatrician in the previous 12-months (OR 5.01; 95%CI 1.05, 23.92; p = .043). Conversely they were less likely to be vaccinated if they were influenced by information from a complementary medicine (CM) practitioner (OR 0.03; 95%CI 0.01, 0.15; p < .001) or had visited a CM-practitioner (OR 0.09; 95%CI 0.02, 0.33; p < .001) in the previous 12-months. A total of 2.6% of parents had immunised their child as a result of the No Jab No Pay legislation, while 3.9% stated the legislation had no effect, and 1.2% said it had made them less likely to vaccinate. A further 1.2% of parents stated they are considering vaccination as a result of the legislative changes. ConclusionParents who have not vaccinated their children appear to trust non-mainstream sources of information such as CM-practitioners. Further research is required to determine how to manage the challenges and opportunities of CM-practitioners as a source of vaccine information.

The Pharmacological Action of Common Herbal Remedies

Acceptance of the clinical efficacy and tolerance of herbal remedies by practitioners of conventional, Western medicine is strongly dependent on unambiguous and reproducible evidence, particularly their pharmacological action. A single conventional drug generally has one dominant pharmacological mode of action which accounts for its therapeutic efficacy, whereas a herbal remedy because of the various active agents it contains, generally influences several biochemical and/or physiological systems present in the body. Identifying this therefore poses several challenges. They are much more complex, and the active components of a herbal remedy may act synergistically or interact in other ways. Although the need to determine modes of action has not been a primary concern of complementary healthcare practitioners, there is increasing pressure to elaborate objectively on their pharmacological action. In response, there has been an encouraging, and escalating, release of scientific data documenting the mode of action of many herbal remedies. Some we know about in considerable detail; of others we have an inkling; but for the vast majority the’ modes of action remain to be elucidated. This brief review, based on a survey of the available scientific and clinical literature, examines the modes of action of several therapeutic herbs which are being increasingly used, whether informally or as part of complementary or integrative medical practice. It examines a major category of sub stances, the adaptogens, and the various chemical forms it embraces, such as the saponins and triterpenes. The herbs with modulate the immune system, for instance garlic, turmeric and St John’s Wort, are likewise surveyed, as are the alkaloids and botanical anti-inflammatory agents. Herbs which exert pharmacological action via their nitric oxide regulatory properties are listed, as are those which provide essential micro-nutrients, such as vitamins and certain minerals. The review concludes with comment on the importance of understanding herbal remedy modes of action as a positive step to their wider adoption in the modern-day therapeutic armamentarium.

Health services research as a framework for expanding a whole systems research agenda in complementary and integrative medicine: The example of intestinal permeability

IntroductionTwo of the three pillars of evidence-based practice emphasise the importance of using the best available academic research and experience from clinical practice to inform patient care. This paper aims to outline the potential value of exploring and describing insights from clinical practice through health services research to inform whole system research. MethodsConcepts and ideas were developed from non-systematic review of published literature and extensive academic and clinical experience within the disciplines of health services research and clinical trials. ResultsThrough deductive reasoning, complementary and integrative medicine (CIM) practitioners may have identified new understanding of the management of disease not yet seen in published literature. The area where investigating CIM practitioners in clinical practice may advance the clinical understanding of particular conditions is extensive. For instance, increased intestinal permeability (IP) is speculated to be involved in diseases frequently seen within clinical practice. IP is considered multifactorial with involvement from genetic and environmental factors. ConclusionsCIM practitioners report clinical experience in the management of digestive disorders; their practice wisdom may add new knowledge to the significance of IP within clinical practice and outline testing parameters. Furthermore, the whole system treatment approach used by CIM practitioners may provide insight into new options for the management of IP not known or shared in published literature. Investigating the approaches CIM practitioners use within clinical practice may provide advancements in the clinical understanding of IP and other conditions. Exploring clinical practice may identify new knowledge that may translate to improvement in patient care.

Prevalence and characteristics of Australian women aged 45 and older who consult acupuncturists for their osteoarthritis.

There is growing acupuncture use amongst people with osteoarthritis, and acupuncture has been shown to have a positive effect on osteoarthritis. The aim of the study is to identify the characteristics of Australian women who consult acupuncturists for osteoarthritis treatment in order to help inform patients, practitioners and policy makers about the range of health care options accessed by older women with osteoarthritis. The research reported here involved participants from a sub-study of the Sax Institute's 45 and Up Study in Australia. The data of 403 Australian women aged 45 and over with osteoarthritis were analysed. Chi-squared tests and stepwise multiple logistic regression modelling were used to determine the characteristics of women who used acupuncture for the treatment of their osteoarthritis. Analysis revealed that 7.7% of women reported using acupuncture in the previous 12months for their osteoarthritis. Acupuncture use is positively associated with women experiencing longer duration of time since initial diagnosis of osteoarthritis (OR=1.04), undertaking more exercise (OR=5.41), living in a rural area (OR=3.62), having consulted a psychologist (OR=12.21), and having consulted another complementary and alternative medicine practitioner (OR=4.18). Our study reveals considerable acupuncture use amongst women with osteoarthritis. There is a need for health care practitioners to be mindful of acupuncture use among their patients presenting with osteoarthritis. Further research is needed to examine the potential benefits of acupuncture for osteoarthritis and to help inform efficient and safe use of this treatment alongside conventional care.

A truly complementary approach: A qualitative exploration of complementary and alternative medicine practitioners' views of treating ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease in which individuals experience a long delay to diagnosis. Prior to diagnosis, individuals report frequent use of complementary and alternative medicine (CAM) therapies. While popularly used, there is a dearth of knowledge concerning the experiences of CAM practitioners in terms of treating individuals with AS. Addressing this knowledge gap, the present study provides a detailed exploration of how UK-based CAM practitioners treat individuals with AS. Semi-structured telephone interviews were conducted with eight UK-based CAM practitioners, (four males), aged 45-69years. CAM practitioners were recruited across a range of CAM therapies and years of CAM practice experience (8-46years). Thematic analysis resulted in the identification of three themes to characterize the data. Themes comprised: (i) the whole picture; (ii) alarm bells; and (iii) a common language. Themes highlighted CAM practitioner adoption of a holistic, yet individualized approach to treating individuals with AS, despite a general sense of lack of knowledge concerning AS among CAM practitioners. Notably, results indicated a desire of CAM practitioners to work more collaboratively with mainstream health providers to provide more joined-up care for individuals with AS. CAM practitioners emphasized the benefits of CAM to focus on providing effective symptom management when used in conjunction, rather than in opposition to, mainstream healthcare. Adoption of a more holistic approach to AS management by CAM practitioners may empower clients to become more aware of symptoms, thus potentially reducing delays in receiving a formal diagnosis of AS.

From knowing silence to curious engagement: The role of general practitioners to discuss and refer to complementary and alternative medicine

Abstract In many OECD countries up to half of the population uses complementary and alternative medicines (CAM). CAM refers to the diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. In those countries nearly all patients will also consult their General Practitioner (GP), and it is therefore important to consider how treatment from these different practitioners might affect the patient-doctor relationship. Despite goodwill on both sides to engage, there may be a mutual reluctance between both patients and GPs to communicate about CAM. To date research has predominately focused upon how GPs perceive CAM with limited studies on the ethical and legal concerns over this necessary dialogue. Drawing upon the data from OECD countries, particularly New Zealand, this paper suggests that, from an ethical standpoint, GPs have a responsibility to discuss CAM with their patients, and potentially refer to, complementary practitioners. Such a responsibility is grounded upon the ethical norms of beneficence (the physician's general duty of care) and the patient's rights of autonomous and informed choices. It encourages effective communication to develop mutual understanding and provide better care to the patient.

Traditional Chinese medicine and Ayurvedic medicine products: a possible cause for concern – the Polish perspective

Abstract Introduction. The demand for Traditional Chinese Medicine (TCM) and Ayurveda have been increasing and there is great potential for complementary medicine development nowadays. However, there are some safety concerns in relation to these products and they hardly ever meet the European Union (EU) requirements for medicines. Moreover, there is no EU-wide legislation governing the regulation of complementary medicine practitioners. Aim. This study aimed to evaluate health risks of the Polish, as part of the European, society associated with the use of TCM and Ayurvedic products. Material and methods. The number of web pages related to TCM and Ayurveda was assessed using popular Internet search engine Google. A questionnaire consisting of 8 close-ended questions was sent to the Polish pharmaceutical and sanitary structures. Chief Sanitary Inspectorate (CSI) in Poland, as well as EU Rapid Alert System for Food and Feed (RASFF) databases, were analysed. Results. There are thousands of web pages offering TCM and Ayurvedic medicines on the Internet. However, only a few such products are registered for the Polish market, thus only a few are supervised. Between 2007 (Jan) and 2018 (Feb) only 0.8% and 0.4% of all food supplement notifications in Poland were related to products from China and India, respectively. Not supervised illegal TCM and Ayurvedic medicines are in 90% adulterated with undeclared substances. Conclusions. TCM and Ayurvedic product irregularities may pose serious health risks to Polish consumers.

The immediate effect of facial candling on inflammatory mediators, substance P, symptoms severity, and quality of life in allergic rhinitis patients: Study protocol for a randomized controlled trial.

Introduction:Asian countries have a variety of ethnic groups and culture that provide their own traditional treatment in health care. Facial candling appears to be one of the popular traditional treatments in Southeast Asian. The complementary medicine practitioners promote that the facial candling treatment would help in reducing the symptoms of allergic rhinitis and other problems related to sinus. Due to the lack of evidence available, the effectiveness of this treatment method and its mechanism, however, remains unknown. The objective of this research is therefore to study impact of facial candling on inflammatory mediators, substance P (SP), symptoms severity, and quality of life (QoL) in allergic rhinitis patients.Method and analysis:A randomized, nonblinded, controlled trial will be carried out by recruiting a total of 66 eligible allergic rhinitis patients who fulfill the inclusion criteria from a university health center. The subjects will be randomly assigned into 2 groups: intervention group receiving facial candling treatment and control group (no treatment given). Samples of blood and nasal mucus will be collected right before and after intervention. Samples collected will be analyzed. The primary outcomes are the changes in the level of SP in both blood and mucus samples between both groups. The secondary outcomes include the levels of inflammatory mediators (ie, tumor necrosis factor alpha, interleukin (IL)-3, IL-5, IL-6, IL-10, and IL-13) and the severity of allergic rhinitis symptoms as measured by a visual analogous scale and QoL using the Rhinitis Quality of Life Questionnaire (RQLQ).Ethical and trial registration:The study protocols are approved from the Ethical and Research Committee of the Universiti Teknologi MARA (REC/113/15). The trial is registered under the Australia New Zealand Clinical Trial Registry (ACTRN12616000299404). The trial was registered on 03/07/2016 and the first patient was enrolled on 10/12/2016.Conclusion:Facial candling is one of the unique treatments using candles to reduce the severity of symptoms and inflammation. This is the first ever study conducted on facial candling that will give rise to new knowledge underlying the effects of facial candling on severity of symptoms and inflammation relief mechanism mediated by substance P and inflammatory mediators.

Complementary Health Practitioners in the Acute and Critical Care Setting: Nursing Considerations.

In response to the rising demand by patients and their families for complementary health approaches, hospitals are increasingly integrating complementary health approaches with their conventional medical practices to create healing environments. Results of the 2010 Complementary and Alternative Medicine Survey of Hospitals indicated that the top 6 inpatient modalities included pet therapy, massage therapy, music or art therapy, guided imagery, relaxation therapy, and Reiki and therapeutic touch. Whether complementary health approaches are provided by complementary health practitioners through hospital-based integrative medicine programs, volunteer practitioners, or bedside nurses, the regulatory, legal, ethical, and safety concerns remain constant. Previous articles in this column of Critical Care Nurse provided an overview of complementary health approaches that nurses may encounter in their practices, with specific attention to implications for acute and critical care nurses, as well as important legal, ethical, safety, quality, and financial implications that acute and critical care nurses should consider when integrating complementary health approaches with conventional care. This column provides the acute and critical care nurse with key information about validation of credentials, experience, and competence of nurses and volunteers providing complementary health approaches, as well as about institutional policies and scope of practice.

Extraordinary Cases of Miraculous Healing

Most healing research has focussed on the views of healers, complementary and alternative medical (CAM) practitioners or medical professionals, and little is known about how the general public conceives of healing. Because healing is a complex and often abstract concept, we addressed this gap in the knowledge using creative qualitative approaches with members of the public. We aimed to elucidate the views of members of the public about their healing, to help offer a better understanding to healthcare professionals.Our qualitative arts-based drawing method invited people to respond using crayons and paper to the question ‘What does the word healing mean to you?’ These drawings were followed by a short recorded interview in which people explained their image. We used convenience sampling to approach members of the public visiting a large wellbeing show and a museum. We analysed images and interviews in tandem using a focus on metaphor.We interviewed 59 people, including three children. Almost two thirds of participants were female. Participants’ images and interviews documented three main models of the healing process: i) Healing comes from a great external force, exemplified by the sun; ii) Healing comes from other people, whether medical professionals, CAM practitioners or healers; and iii) Healing comes from within, and the individual has the ability to self-heal. People described practices and inner states that could help achieve healing. Some people depicted more than one model, demonstrating the interlinkages between the models, and some described the outcome of healing (wholeness) rather than the process.The drawing-based approach encouraged an intuitive way of thinking, capturing concepts that cannot easily be verbalised. Members of the public have nuanced, complex understandings of the concept of healing, and these echo historical and modern concepts of healing and healthcare. The models our participants described often interlink, suggesting an overarching framework for the way people conceive of healing. The findings may be useful both as a guide to further research and as insight that may facilitate healthcare processes.

Clinical, cultural and psychosocial impediments to self reporting of erectile dysfunction by men in Edo state, Nigeria

IntroductionOrganic ED is presently considered as vasculogenic in the majority of affected middle age and elderly men and a sentinel event for cardiovascular disease. When men present with ED, it is advised that the opportunity should be used to assess their cardiovascular health. ObjectiveTo determine the impediments to self reporting of ED and to assess the help seeking habits of men in Edo state with regards to ED. The secondary objective is to evaluate how acceptable sexual assessment is to these men when they present. Subjects and methodsThis is a cross sectional study using a multi-facet, questionnaire with a section consisting of the international index of erectile function (IIEF). All men above 30 years who consented were included. ResultsThe response rate was 71.1%. The mean IIEF score was 20.33 with standard deviation of 4.656. The overall prevalence of ED was 51.2. Three hundred and eight of the respondents (33.3%) did not know where ED is treated, 273 (29.5%) thought that it is treated by complementary and alternative medicine practitioners while 237 (25.6) opted for the hospital as a point of care. This had a statistically significant correlation with location of the respondent (P=0.000), level of education (P=0.000) and senatorial zone (P=0.000). Sexual evaluation was acceptable to 384 (41.5%) respondents when men present without ED and 757 (81.8%) when ED has occurred. This had a statistically significant correlation with level of education (P=0.000), alcohol consumption (P=0.000) and senatorial zone (P=0.000). ConclusionsED is highly prevalent in this community. Alcohol consumption, low educational level, ignorance of who and where ED is treated, location of respondent (rural) indifference, presence of co-morbidities and tribal beliefs appear to be associated with low self reporting. Affected men are more likely to patronize complementary and alternative medicine (CAM) practitioners than medical practitioners or may be out rightly indifferent. Acceptability of sexual evaluation of men is low when ED is absent and high when it has occurred.