Integrated Health Clinic Research Articles

Implementing paper-based patient-reported outcome collection within outpatient integrative health and medicine.

To investigate the feasibility of pre- and post-encounter patient-reported outcome (PRO) measure collection within an outpatient integrative health and medicine (IHM) clinic and to characterize factors associated with successful completion. We conducted a retrospective review of 27,464 outpatient IHM encounters including 9,520 chiropractic; 8,237 acupuncture; 5,847 massage; 2,345 IHM consultation; and 1,515 osteopathic manipulation treatment encounters at four clinics offering IHM over 18 months. Patients were asked to complete paper questionnaires rating pain, anxiety, and stress from 0-10 immediately pre- and post-encounter. Generalized linear mixed effect regression models were used to examine the relationship between demographic, clinical, and operational covariates and completing (1) pre-encounter and (2) paired (i.e., pre and post) PROs. Patients (N = 5587, mean age 49 years, 74% white, 77% female) generally presented for musculoskeletal conditions (81.7%), with a chief complaint of pain (55.1%). 21,852 (79.6%) encounters were among patients who completed pre-encounter PROs; 11,709/21,852 (53.6%) completed subsequent post-encounter PROs. Odds of PRO completion were more impacted by provider, operational, and clinical-level factors than patient factors. Covariates associated with increased odds of pre-encounter PRO completion included being female, having additional IHM encounters, and having a pain or anxiety complaint. Covariates associated with increased odds of paired PRO completion included being aged 31-40 vs. 51-60 years and having additional IHM encounters. Implementing a paper-based PRO collection system in outpatient IHM is feasible; however, collecting post-encounter PROs was challenging. Future endeavors should leverage the electronic health record and patient portals to optimize PRO collection and engage patients and clinical providers.

Evaluation of a New Integrative Health and Wellness Clinic for Veterans at the San Francisco VA Health Care System: A Mixed-Methods Pilot Study.

The Integrative Health and Wellness Clinic (IHWC), established in 2019 at the San Francisco VA Health Care System, is an interdisciplinary clinic consisting of a medical provider, dietician, physical therapist, and psychologist trained in complementary and integrative health (CIH) following the VA Whole Health model of care. Veterans with complex chronic conditions seeking CIH and nonpharmacologic approaches are referred to the IHWC. This study evaluated the clinic's acceptability and feasibility among veteran patients and its preliminary impact on health and wellbeing, health-related goals, and use of CIH approaches. Mixed methods were used to assess patient-reported outcomes and experiences with the IHWC. Participants completed surveys administered at baseline and 6-months and a subset completed a qualitative interview. Pre- and post-scores were compared using t-tests and chi-square tests. Thirty-five veterans completed baseline and 6-month follow up surveys. Of these, 13% were women; 24% < 50 years of age, and 44% identified as racial/ethnic minorities. Compared to baseline, at 6 months, there were significant (P < .05) improvements in overall health, physical health, perceived stress, and perceived helpfulness of clinicians in assisting with goal attainment; there was a trend toward improved mental health (P = .057). Interviews (n = 25) indicated satisfaction with the interdisciplinary clinical model, support of IHWC providers in goal attainment, and positive impact on physical and mental health. Areas for improvement included logistics related to scheduling of multiple IHWC providers and referrals to other CIH services. Results revealed significant improvement in important clinical domains and satisfaction with interprofessional IHWC clinic providers, but also opportunities to improve clinic processes and care coordination. An interdisciplinary clinic focused on CIH and Whole Health is a feasible and acceptable model of care for veterans with complex chronic health conditions in the VA healthcare system.

Design and Implementation of a Program Development Practicum for Faculty Education and Advancement of Clinical Programs.

Physicians are often tasked to develop and lead collaborative, program development efforts but many have limited formal training. We designed and evaluated a professional development workshop series to provide our faculty members with a framework and tools for the development of clinical programs: the Program Development Practicum (PDP). Faculty identified a clinical program of focus and for each clinical program identified, a program proposal, SBAR communication (situation, background, assessment, recommendation), executive summary, 1-min elevator pitch, and budget was developed. Five clinical programs were identified for improvement including: Inflammatory Bowel Disease, Celiac Disease, Transition of Care, Integrative Health Clinic, and Endoscopic Procedures. At the conclusion of the PDP, these programs were presented to key hospital leaders and resulted in an investment of resource support. Faculty also reported increased understanding of overall program development with the largest gains in knowledge in proposal writing and marketing. Overall, the PDP allowed for a revamp of key clinical services and faculty clarity on resource availability and expectations. We plan to continue with annual engagement of hospital leaders to share updates.

From ‘pain management’ to ‘integrated health clinic’: a quality improvement project to transition patients on chronic opioid therapy to more evidence-based therapies for chronic pain

BackgroundThe State of New York, along with the whole nation, is struggling to combat the opioid epidemic. Major authoritative bodies on chronic pain and addiction have advocated against the use...

Transcriptional modulation of inflammation, and aging in Indian obese adults following a 12-week yoga-based lifestyle intervention: A randomized controlled trial.

IntroductionObesity is one of the major global problems in today's world, both in children, and the adult age group. Current evidence suggests obesity alters the expression of various genes related to oxidative stress, inflammation, and aging. In recent times complementary therapy like yoga-based lifestyle intervention (YBLI) is used as an adjunct therapy to modern medicine. This study examines the efficacy of 12 weeks of yoga-based lifestyle intervention with standard care (SC) on the expression of genes related to oxidative stress, inflammation, and aging in obese adults.MethodsThis was a two-arm parallel randomized control trial implemented at Integral Health Clinic (IHC), an outpatient facility that regularly conducted YBLI programs for the prevention of lifestyle diseases like obesity and diabetes in the Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi. Blood samples at baseline and weeks 2,4, and 12 were collected from 72 adults (male n = 21; female n = 51) of age 20–45 years with a body–mass index (BMI) of 25–35 kg/m2 who were randomized to receive either a 12-week SC (n = 36) or YBLI (n = 36). SC included recommendations for the management of obesity as per Indian guidelines including a low-calorie individualized diet and physical activity. Asana (physical postures), pranayama (breathing exercises), and meditation were all part of the YBLI. Primary outcomes were relative fold change in the expression of genes associated with oxidative stress [Nuclear factor-kappa B (NF-Kappa B)], inflammation [Tumor necrosis factor-α (TNFα), interleukin-6 (IL-6)], and aging [human telomerase reverse transcriptase (TERT)] in peripheral blood mononuclear cells between the two groups at week-12.ResultsThere were no significant changes in fold change of TERT, IL-6, and NF-kappa B between the groups at week 12. The relative fold change of TERT was significantly greater in the YBLI group (p = <0.0001) vs the SC group at 2 weeks. The relative fold change of TNF α was significantly lower at week 12 in YBLI though the change was not continuous and reliable. Within both groups, TERT expression was significantly increased at week 2 though the change was greater in the YBLI group (p < 0.0001). TNF α gene expression was significantly lower at weeks 2 and 4, compared to baseline level, in the SC group but it increased at week 12.ConclusionThe results while did not confirm our hypothesis, are important to share with the scientific society, to be able to improve prospective study designs and find optimal time/intervention/biological marker settings for this highly important scientific field. The results are suggestive of a positive impact of YBLI and SC on the fold change of aging-related TERT gene in obesity, though the benefit was not evident till week 12. However, the results should be evaluated with caution and in light of other published studies. To better understand the positive effects of YBLI on oxidative stress, inflammation, and aging-related gene expression in obesity, larger studies are recommended.

Effect of photobiomodulation on fatigue in individuals with relapsing-remitting multiple sclerosis: a pilot study.

Multiple sclerosis is an autoimmune disease of the central nervous system characterized by inflammation and destruction of the myelin sheath. Fatigue is one of the main symptoms of this disease, with a negative impact on quality of life and few treatment options. Photobiomodulation is used for several inflammatory conditions and may be beneficial for the treatment of fatigue in individuals with multiple sclerosis. Conduct a pilot study to analyze the effect of photobiomodulation on fatigue in individuals with relapsing-remitting multiple sclerosis. The participants were recruited from the UNINOVE Integrated Health Clinic and randomly allocated to two groups: group 1, administration of photobiomodulation (808nm, 36J for 360s) under the tongue and group 2, administration of photobiomodulation over the radial artery. Fatigue was measured using the Modified Fatigue Impact Scale (MFIS). No significant differences were found regarding the total MFIS score or subscale scores (p < 0.05, two-way ANOVA). Photobiomodulation with the parameters employed in the present study had no effect on fatigue in individuals with multiple sclerosis. ClinicalTrials.gov Identifier: NCT03360487.

The Impact of Pet Ownership on Healthcare-Seeking Behavior in Individuals Experiencing Homelessness

ABSTRACT The objective of this research was to understand the effect of pet ownership on healthcare-seeking behavior among persons experiencing homelessness with animals. Mixed-method, semi-structured interviews were conducted with 44 people experiencing homelessness with animals in Seattle, Washington to collect stories of barriers and facilitators due to animal ownership, health-seeking behaviors for themselves and their animals, and self-assessed health status and health conditions of the owners and their pets. The interviews also explored the ways in which the participants would like to receive healthcare services for themselves and their animals. Quantitative results showed that the medical care sourced for pets exceeded that for the owner’s own health, with 86% of participants seeking healthcare for themselves within the past year and 93% of participants seeking veterinary care for their pet within the past year. Results also displayed self-described health of the animal faring better than that of the owner, with 47% of participants reported being “Healthy” or “Very healthy” compared with 90% of pets being reported as the same. Themes emerging from the qualitative research included that persons experiencing homelessness with animals place a high value on the health and welfare of their pets, that the animals can pose a barrier to traditional health services and access to overall services, and that the owner’s need for animal companionship and support is high. These findings suggest that utilizing the human–animal bond and creating integrated (human and animal), interprofessional health services using a One Health approach for unhoused populations owning pets can reduce barriers to services and improve both human and animal health. In an integrated health clinic setting, the owner may seek care for their animal but stay for the human healthcare.

A 12-Week Yoga-Based Lifestyle Intervention Might Positively Modify Cellular Aging in Indian Obese Individuals: A Randomized-Controlled Trial.

Background: Telomeres and telomerase are considered cardinal biomarkers of cellular aging. Shorter telomeres and low telomerase activity have been associated with obesity and accelerated aging. Objective: To compare the effects of a yoga-based lifestyle intervention (YBLI) with the standard of care (SOC) on cellular aging by estimating telomere length (TL) and telomerase activity in obesity. Design and setting: A parallel, two-arm, randomized-controlled trial was conducted at the Integral Health Clinic, Department of Physiology, All India Institute of Medical Sciences, New Delhi, from March 2017 to October 2019. Participants: Obese (n = 72), body mass index (BMI), 25-35 kg/m2, aged 20-45 years, male (21), and female (51). Intervention: Seventy-two obese participants were randomized to receive either a 12-week SOC (n = 36) or YBLI (n = 36). SOC included management of obesity as per Indian guidelines including a hypocaloric individualized diet and physical activity. The pretested YBLI included asana (physical postures), pranayama (breathing exercises), and meditation. Methods: Blood samples were collected from both the groups at baseline, 2, 4, and 12 weeks. DNA was extracted from peripheral blood mononuclear cells. TL was measured by quantitative PCR, and serum telomerase levels by immunoassay. Outcome measures: Primary outcome measures were the changes in the TL and telomerase levels between the two groups at week 12. Secondary outcome measures were the changes in TL and telomerase, and anthropometric parameters (body weight, BMI, waist-to-hip ratio) at 2, 4, and 12 weeks of intervention in both SOC and YBLI groups. Results: There were no significant changes in TL and telomerase levels between the groups at week 12. The TL was significantly greater in the YBLI group versus the SOC group (p < 0.0001) at 2 weeks. The anthropometric and physiological parameters were influenced positively by both SOC and YBLI. Conclusion: The study did not meet the primary objective, although the results are suggestive of a positive impact of YBLI on aging in obesity as noted within the YBLI group. However, the results should be interpreted carefully, and in the light of other published data. Larger studies to better understand the possible positive benefits of YBLI on cellular aging are recommended. Clinical Trail Registration No. CTRI/2016/08/007136.

Estradiol and Testosterone Concentrations Among Thai Transgender Women in a Transgender-Led, Integrated Gender-Affirming Care and Sexual Health Clinic: A Real-World Analysis.

Feminizing hormone therapy (FHT) is used by many transgender women as a pharmacological method to mitigate gender dysphoria. However, information on hormone concentrations among those who use FHT is lacking. We aimed to determine the proportion of Thai transgender women who were using FHT who had hormone concentrations within target ranges in a real-world clinic setting. Transgender women who attended Tangerine Clinic in Bangkok, Thailand, reported current use of FHT at clinic entry, and tested for both blood estradiol (E2) and total testosterone (TT) concentrations were included in the analysis. Hormone target concentrations were defined as 100-200 pg/mL for E2 and <50 ng/dL for TT. Of 1534 transgender women included, 2.5% had undergone orchiectomy, and 524 (34.2%) had any hormones within target concentrations. Median (interquartile range) E2 and TT concentrations at baseline were 29 (14.3-45.3) pg/mL and 298.5 (22-646) ng/dL, respectively. Among those who had any hormones within target concentrations, 28 (1.8%), 11 (0.7%), and 485 (31.6%) had both hormones, only E2, and only TT within target concentrations, respectively. Among 1010 (65.8%) transgender women who had neither hormone within target concentrations, 989 (64.5%) and 21 (1.4%) had suboptimal and supraphysiological E2 concentrations, respectively. Among those who came to at least one follow-up visit (n=302), 165 (54.6%) transgender women managed to achieve or maintain either hormone within target concentrations. One-third of Thai transgender women who were using FHT had any hormones within target concentrations at baseline in this real-world setting study. Most transgender women who had neither hormone within target concentrations had suboptimal rather than supraphysiological E2 concentrations. More than half managed to achieve or maintain at least one hormone concentration within target concentrations at follow-up visits, suggesting a positive effect from attending a trans-led, integrated gender-affirming care and sexual health service.

Mindfulness-based waiting room intervention for osteopathic manipulation patients: a pilot randomized controlled trial.

Osteopathic manipulative treatment (OMT) and mindfulness-based interventions are both efficacious pain management strategies. Combining these two therapeutic approaches may offer added benefits to pain patients. To determine whether engaging in a mindfulness-based intervention before an OMT session improved OMT session outcomes. Patients seeking OMT care from a single osteopathic physician at an integrative health clinic were recruited for this pilot randomized, controlled trial at an academic hospital. All patients scheduled for osteopathic structural evaluation and treatment with the provider from March 2019 to September 2019 were eligible and invited to participate during the reminder call before their visit. Participants were randomly assigned to listen to one of two audio recordings matched for length: (1) the history of osteopathic medicine, or (2) a guided mindfulness meditation practice. Patients completed surveys including numeric rating scales to measure mindfulness and embodied safety (a self-reported feeling that the patient's body was in a safe place) immediately before and after listening to the audio recording. A global pain rating report along with a sensation manikin (a digital human figure silhouette overlaid with a grid of 786 "sensation" pixels) capturing both pleasant and unpleasant sensation were collected before and after the OMT session. Session satisfaction was also assessed with a single survey item. A total of 57 participants were enrolled in the study; however, 18 were unable to listen to the full audio recording and were excluded from further analysis. The final study sample consisted of 39 patients, with 19 (48.7%) randomized to the history audio recording and 20 (51.3%) randomized to the mindfulness recording. The mean age of patients was 57 years (standard deviation, 11.75 years); 25 (64.1%) were women and 14 (35.9%) were men. The most common primary pain location was the neck (16; 41.0%), followed by back (12; 30.8%) and joint (5; 12.8%). Twenty (51.3%) participants were cancer patients; 19 (48.8%) did not have a cancer diagnosis. Practicing mindfulness before OMT increased patients' sense of mindful connection to (p=0.036) and safety within (p=0.026) their bodies as well as their overall session satisfaction (p=0.037). Additionally, OMT paired with either study condition (mindfulness vs. history) decreased pain (p<0.001) and increased the ratio of pleasant to unpleasant sensations reported by patients (p<0.001). Finally, regardless of experimental condition (mindfulness vs. history), increased safety within the body predicted greater pain relief (β=-0.33, p=0.035) and larger sensation ratio changes (β=0.37, p=0.030) at the OMT session's end. Additionally, increased mindful connection to the body predicted less pain (β=-0.41, p=0.005) at the session's end. This study demonstrated the feasibility of integrating a mindfulness-based intervention with OMT and results suggest that having patients listen to an audio-guided mindfulness practice while waiting for their OMT session may increase their mindful connection to and safety within their bodies as well as their session satisfaction. This study also provides empirical evidence that OMT may increase the distribution of pleasant sensations reported by pain patients while decreasing the distribution of unpleasant sensations reported.

Effect of a weight loss program on serum adiponectin and insulin resistance among overweight and obese premenopausal females

BackgroundObesity has emerged as a public health crisis in many populations including Egypt. Adipose tissue produces a number of adipokines, one of them is adiponectin which has attracted much attention because of its antidiabetic and antiatherogenic effects.ObjectiveTo determine the effect of a weight loss program on serum adiponectin level and insulin resistance among overweight and obese adult premenopausal females.Study designA pre-postintervention study was carried out among 95 premenopausal overweight and obese females (body mass index ≥ 25 kg/m2) aged 20 to 40 years at the integrated health clinic affiliated to the High Institute of Public Health, Alexandria, Egypt, from February 2016 to February 2017. All participants underwent a weight loss program based on a reduced calorie balanced diet and advised to increase their physical activity. Dietary instructions and follow-up were done weekly throughout 16 weeks. Blood samples were collected to investigate serum adiponectin level and insulin resistance at the beginning and the end of the intervention.ResultsAfter 16 weeks, a significant decrease in body weight by 9.7% was associated with a significant increase in serum adiponectin from 13.3 ± 4.9 μg/ml to 18.5 ± 5.6 μg/ml. Both fasting insulin and insulin resistance had decreased significantly by 13.6% and 13.7%, respectively.ConclusionA weight reduction program depending on a reduced calorie diet for 16 weeks was associated with a significant increase in total adiponectin level and reduction in insulin resistance. An emphasis on the importance of keeping normal weight through nutritional education and the promotion of healthy diets is recommended to reduce the risk of occurrence of insulin resistance, type 2 diabetes, and cardiovascular diseases.

Consumo de alimentos ultraprocessados por idosos frequentadores de uma clínica integrada de saúde em São Paulo

Objetivo: avaliar o consumo de alimentos ultraprocessados por idosos atendidos em uma clínica escola de saúde em São Paulo, considerando o seu estado nutricional, sexo e presença ou não de hipertensão. Métodos: Estudo transversal com 78 idosos (≥ 60 anos de idade), de ambos os sexos, realizado com frequentadores de uma Clínica integrada de Saúde. Os dados foram coletados entre janeiro de 2013 e dezembro de 2018. Esta pesquisa faz parte do projeto de pesquisa temático denominado: “Avaliação Interdisciplinar da Saúde do idoso”. As variáveis quantitativas foram testadas para normalidade pelo teste de Kolmogorov Smirnov, não apresentando normalidade. Portanto, diferenças entre as médias de consumo de ultraprocessados entre idosos e idosas, hipertensos e normotensos, eutróficos e sobrepeso, foram analisadas por teste Mann-Whitney (p0,05). Resultados: Identificou-se que 65,4% (n=51) dos indivíduos eram normotensos e 34,6% (n=27) eram hipertensos. Notou-se que os idosos apresentaram um maior consumo de refrigerante, hambúrguer e biscoito recheado do que as idosas, os eutróficos apresentaram um maior consumo de pão de forma/bisnaguinha do que os indivíduos com sobrepeso e os hipertensos apresentaram maior consumo de margarina quando comparados aos normotensos. Conclusão: As ações de prevenção de fatores de risco para as DCNT, como a hipertensão, além da promoção de hábitos de vida saudáveis focadas na redução do consumo de alimentos ultraprocessados, são componentes fundamentais para contribuir para uma melhor qualidade de vida nessa faixa etária, principalmente entre as mulheres idosas, que apresentaram maior prevalência de hipertensão e maior consumo de ultraprocessados como biscoito recheado, refrigerante e hambúrguer.

Effects of Photobiomodulation in Children with Down Syndrome and Possible Sleep Bruxism: Protocol For A Randomized, Controlled, Blind, Clinical Trial: Study protocol clinical trial (SPIRIT compliant).

Hypotonia, particularly of the masticatory and oropharyngeal muscles, is 1 of the main characteristics of Down Syndrome (DS), resulting in impaired speech, chewing and swallowing. Moreover, the complete or partial obstruction of the airways during sleep may occur due to hypotonia of the tongue, leading to snoring and sleep disorders, such as obstructive apnea and sleep bruxism.Objective:Analyze salivary levels of dopamine and cortisol and muscle activity before and after treatment with low-level laser therapy administered to acupoints in children with DS.Methods:A randomized, controlled, clinical trial will be conducted. Individuals 4 to 17 years of age with a diagnosis of DS and possible sleep bruxism will be screened at the Integrated Health Clinic of Nove de Julho University. We will evaluate orofacial dysfunction (Nordic Orofacial Test - Screening questionnaire), Masseter muscle activity during sleep will be assessed by BiteStrip and the masticatory muscles will be evaluated by electromyography (BTS TMJOINT) head posture as well as salivary cortisol and dopamine. After the evaluations, the participants will be randomized into 2 groups: Grupo 1 – treatment with low-level laser therapy at a wavelength of 808 nm; Group 2 – sham treatment (simulated laser therapy). Treatment will be conducted twice per week for a total of 12 sessions. The data will be tabulated and treated using GraphPad Prism version 7.0. The Kolmogorov-Smirnov test will be used to determine the normality of the data. Variables that fit the Gaussian curve will be expressed as mean and standard deviation. The ANOVA 2-way will be used for comparisons between the groups, with the significance level set to 5% (P < .05).ClinicalTrials registration number: NCT04211870.

Integrative Behavioral Health Clinic: A Model for Social Work Practice, Community Engagement, and In Vivo Learning

ABSTRACTMissouri did not expand Medicaid, leaving about 500,000 Missourians without health insurance. To address community needs and provide additional social work training opportunities, a free integrated behavioral health clinic was established. This article discusses the need, describes the clinic, and presents 1-year evaluation results. Sixty-nine clients received services, and 30 students received intensive training during the first year. Almost half of the clients were diagnosed with depressive disorders, and more than half had comorbid medical conditions. Psychiatric symptoms were lower following treatment. Quality of life increased in physical and psychological domains. Collaborative clinics with social work and medical students are a viable option for experiential learning and providing quality care for uninsured or underinsured people with comorbid medical conditions.

Trigger Point Dry Needling.

Increasingly, physical therapists in the United States and throughout the world are using dry needling to treat musculoskeletal pain, even though this treatment has been a controversial addition to practice. To better generalize to physical therapy practice the findings about dry needling thus far, the authors of a study published in the March 2017 issue of JOSPT identified the need for a systematic review examining the effectiveness of dry needling performed by physical therapists on people with musculoskeletal pain. Their review offers a meta-analysis of data from several included studies and assesses the evidence for risks of bias. J Orthop Sports Phys Ther 2017;47(3):150. doi:10.2519/jospt.2017.0502.

High-density lipoprotein cholesterol increases following a short-term yoga-based lifestyle intervention: a non-pharmacological modulation

Objectives The objective of the study was to assess the effect of a brief but comprehensive yoga-based lifestyle intervention on highdensity lipoprotein cholesterol (HDL-c).Methods This prospective interventional study was performed at the Integral Health Clinic (IHC), an outpatient facility at All India Institute of Medical Sciences, New Delhi, a tertiary health care centre, conducting yoga-based lifestyle intervention programmes for prevention and management of chronic diseases. The study included apparently healthy normal weight, overweight and obese subjects who underwent a pretested 10-day yoga-based programme including asanas (postures), pranayama (breathing exercises), meditation, group discussions, lectures and individualized advice on stress management and healthy diet. The primary outcome measure was change in serum HDL-c at day 10 versus day 0.Results 238 participants (147 women, 91 men, 38.81 ± 11.40 years) were included in the study. There was a significant increase in HDL-c levels from baseline to day 10 (42.93 ± 5.00 vs 43.52 ± 5.07 mg/dL, P = 0.043). Notably, HDL-c was significantly improved in those for whom the baseline HDL-c levels were lower than the recommended values. Also, there was a reduction in blood pressure, fasting blood glucose, and improvement in other lipid profi le variables.Conclusion This yoga-based lifestyle intervention significantly increased HDL-c levels in a short duration of 10 days. This has additional clinical relevance as HDL-c is suggested to be one of the strongest statistically independent predictors of major cardiovascular events.

Paradigm Shift: Stages of Physicians' Entry into Integrative Practice

Integrative medicine and psychiatry are more than areas of interest; they represent a clear philosophic paradigm with a wide range of beliefs that separate it from conventional care. A child psychiatrist will typically pass through a developmental trajectory as he or she begins to embrace this approach to patient care, which can be broken down into common stages that represent the incorporation and expression of a new philosophy. This article outlines those common stages of development, and also walks through the process of opening an integrative mental health clinic.

Adiponectin, Interleukin-6, and Cardiovascular Disease Risk Factors Are Modified by a Short-Term Yoga-Based Lifestyle Intervention in Overweight and Obese Men

To investigate the effect of a short-term yoga-based lifestyle intervention on risk factors for cardiovascular disease (CVD) and markers of inflammation and endothelial function in overweight and obese men. Nonrandomized prospective lifestyle intervention study with pre-post design. SETTING AND LOCATION: Integral Health Clinic, an outpatient facility providing yoga-based lifestyle intervention programs for prevention and management of chronic diseases. Overweight and obese men (n=51) were enrolled in the study. Subjects who were physically unable to participate and those participating in other interventions were excluded from the study. A pretested intervention program including asanas (physical postures), pranayama (breathing exercises), group discussions, lectures, and individualized advice. The primary outcome measure was weight loss, and the secondary outcome measures were clinical and laboratory correlates of CVD risk, levels of interleukin-6 (IL-6), adiponectin, and endothelin-1 (ET-1). Men (n=51, body mass index [BMI] 26.26±2.42 kg/m(2)) were enrolled and underwent a yoga-based lifestyle intervention for 10 days. Of 51 subjects, 30 completed the study. There was a significant reduction in weight from Baseline to Day 10 (74.60±7.98, 72.69±8.37 kg, p<0.001, respectively), BMI (26.26±2.42, 25.69±2.47 kg/m(2), p<0.001, respectively), and systolic BP (121.73±11.58, 116.73±9.00, p=0.042, respectively). There was a significant reduction in plasma IL-6 from Baseline to Day 10 (median 2.24 vs. 1.26 pg/mL, respectively, p=0.012). There was a significant increase in the plasma adiponectin from Baseline to Day 10 (median 4.95 vs. 6.26 μg/mL, respectively, p=0.014). Plasma ET-1 level remained unchanged. These findings suggest that even a short-term yoga-based lifestyle intervention may be an important modality to reduce the risk for CVD as indicated by weight loss, reduction in systolic blood pressure, an increase in adiponectin, and decrease in IL-6 in overweight and obese men.

Efficacy of a Short-Term Yoga-Based Lifestyle Intervention in Reducing Stress and Inflammation: Preliminary Results

Previously it was shown that a brief yoga-based lifestyle intervention was efficacious in reducing oxidative stress and risk of chronic diseases even in a short duration. The objective of this study was to assess the efficacy of this intervention in reducing stress and inflammation in patients with chronic inflammatory diseases. This study reports preliminary results from a nonrandomized prospective ongoing study with pre-post design. The study was conducted at the Integral Health Clinic, an outpatient facility conducting these yoga-based lifestyle intervention programs for prevention and management of chronic diseases. Patients with chronic inflammatory diseases and overweight/obese subjects were included while physically challenged, and those on other interventions were excluded from the study. A pretested intervention program included asanas (postures), pranayama (breathing exercises), stress management, group discussions, lectures, and individualized advice. There was a reduction in stress (plasma cortisol and β-endorphin) and inflammation (interleukin [IL]-6 and tumor necrosis factor [TNF]-α) at day 0 versus day 10. Eighty-six (86) patients (44 female, 42 male, 40.07 ± 13.91 years) attended this program. Overall, the mean level of cortisol decreased from baseline to day 10 (149.95 ± 46.07, 129.07 ± 33.30 ng/mL; p=0.001) while β-endorphins increased from baseline to day 10 (3.53 ± 0.88, 4.06 ± 0.79 ng/mL; p=0.024). Also, there was reduction from baseline to day 10 in mean levels of IL-6 (2.16 ± 0.42, 1.94 ± 0.10 pg/mL, p=0.036) and TNF-α (2.85 ± 0.59, 1.95 ± 0.32 pg/mL, p=0.002). This brief yoga-based lifestyle intervention reduced the markers of stress and inflammation as early as 10 days in patients with chronic diseases; however, complete results of this study will confirm whether this program has utility as complementary and alternative therapy.

P02.75. Outcome evaluation of the Veterans Affairs Salt Lake City Integrative Health Clinic for chronic nonmalignant pain and stress

Purpose The purpose of this longitudinal outcome study was to determine the effectiveness of the Integrative Health Clinic and Program (IHCP) and to perform a subgroup analysis investigating patient benefit. The IHCP is the first organized integrative health clinical service within the Veterans Affairs Health Care System utilizing research based Complementary and Alternative Medicine (CAM), mind-body skills, and conventional treatments based on a health promotion and wellness model for the bio-psychosocial management of chronic non-malignant pain and stress related depression, anxiety, and symptoms of PTSD.