Non-pharmacological Alternatives Research Articles

Effects of a dual intervention (motor and virtual reality-based cognitive) on cognition in patients with mild cognitive impairment: a single-blind, randomized controlled trial

BackgroundThe increase in cases of mild cognitive impairment (MCI) underlines the urgency of finding effective methods to slow its progression. Given the limited effectiveness of current pharmacological options to prevent or treat the early stages of this deterioration, non-pharmacological alternatives are especially relevant.ObjectiveTo assess the effectiveness of a cognitive-motor intervention based on immersive virtual reality (VR) that simulates an activity of daily living (ADL) on cognitive functions and its impact on depression and the ability to perform such activities in patients with MCI.MethodsThirty-four older adults (men, women) with MCI were randomized to the experimental group (n = 17; 75.41 ± 5.76) or control (n = 17; 77.35 ± 6.75) group. Both groups received motor training, through aerobic, balance and resistance activities in group. Subsequently, the experimental group received cognitive training based on VR, while the control group received traditional cognitive training. Cognitive functions, depression, and the ability to perform activities of daily living (ADLs) were assessed using the Spanish versions of the Montreal Cognitive Assessment (MoCA-S), the Short Geriatric Depression Scale (SGDS-S), and the of Instrumental Activities of Daily Living (IADL-S) before and after 6-week intervention (a total of twelve 40-minutes sessions).ResultsBetween groups comparison did not reveal significant differences in either cognitive function or geriatric depression. The intragroup effect of cognitive function and geriatric depression was significant in both groups (p < 0.001), with large effect sizes. There was no statistically significant improvement in any of the groups when evaluating their performance in ADLs (control, p = 0.28; experimental, p = 0.46) as expected. The completion rate in the experimental group was higher (82.35%) compared to the control group (70.59%). Likewise, participants in the experimental group reached a higher level of difficulty in the application and needed less time to complete the task at each level.ConclusionsThe application of a dual intervention, through motor training prior to a cognitive task based on Immersive VR was shown to be a beneficial non-pharmacological strategy to improve cognitive functions and reduce depression in patients with MCI. Similarly, the control group benefited from such dual intervention with statistically significant improvements.Trial registrationClinicalTrials.gov NCT06313931; https://clinicaltrials.gov/study/NCT06313931.

Potential Herbal Remedies for Treatment of Depression: A Mini Review

Background:: Depression is a psychiatric and mood disorder that impacts a person's mental health and behavior and is frequently linked to suicide. As per the World Health Organization's estimate, depressive disorder will be the main cause of mental disorders by the year 2030, and it has a huge impact on the burden of disease in the world. To treat depression, there are pharmacological and nonpharmacological therapy alternatives. With little to no consideration of other neurochemicals altered in depression, most antidepressant preparations are based on the monoamines, neuroendocrine, and neuro-inflammation concepts. Objective:: The present study aims to provide comprehensive data related to depression, the factors associated, the mechanism involved, herbal plants effective for managing depression, and novel formulations along with patents and clinical trials. Methods:: A thorough assessment of herbs and novel formulations that have been proven effective in treating depression was conducted. After extensive review, the present study includes a mechanism of action of herbal plants showing antidepressant effects, novel formulations, patents, and clinical trials related to depression. Results:: Numerous studies reported that diverse herbal plants have been found to have a positive effect on depression management, such as Panax ginseng, Melissa officinalis, Piper methysticum, Schinus molle L, Kielmeyera coriacea Mart, Elaeocarpus ganitrus, Hypericum perforatum, Lavandula angustifolia Mill, Crocus Sativus L. Conclusion:: Herbal plant research could help establish the potential of isolated compounds from plants with medicinal properties for managing depressive illnesses.

Evaluating the Effectiveness of Transcutaneous Electrical Nerve Stimulation for Various Outcomes in Emergency Department Settings: A Systematic Review and Meta-Analysis.

Pain is a prevalent complaint in emergency departments (EDs) worldwide. Traditional pharmacological methods for pain relief, such as opioids and non-steroidal anti-inflammatory drugs (NSAIDs), have notable side effects and risks. Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological alternative that has shown promise in various clinical settings. This systematic review and meta-analysis aimed to evaluate the effectiveness of TENS for pain management and other outcomes in ED settings. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted across six major databases: PubMed, Web of Science (WOS), Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), from inception until June 25, 2024. Randomized clinical trials involving the use of TENS in ED settings were included. Data extraction and quality assessment were performed independently by two reviewers, with conflicts resolved by a third reviewer. The search yielded 3,569 papers, of which 2,889 were screened after removing duplicates. Thirteen full-text articles were reviewed, and seven studies met the inclusion criteria for qualitative synthesis, with five of these suitable for meta-analysis. The studies demonstrated that TENS significantly reduced pain, heart rate, and the requirement for rescue medication in some cases, while also improving patient satisfaction and overall well-being. However, no significant changes were observed in blood pressure. The quality of the included studies varied, with some failing to meet the criteria for blinding and intention-to-treat analysis. TENS is an effective non-pharmacological intervention for pain management in ED settings, with additional benefits such as reduced heart rate and increased patient satisfaction. Further high-quality randomized controlled trials are necessary to confirm these findings and better understand the potential of TENS in acute care environments.

Advances on the Experimental Research in Resistant Hypertension.

Resistant Hypertension (RH) poses a significant public health challenge, contributing to increased mortality, cardiovascular events and organ damage. Both clinical and experimental research are striving for higher standards in a translational manner to integrate new findings and confirm hypotheses. Considering that many are the aspects of RH that are still under investigation, this review aims to shed light on the advances made in experimental research concerning RH. It seeks to underscore the pivotal role of experimental studies in shaping clinical practices and also explore future perspectives. It is important to emphasize the significance of experimental models, primarily for advancing our understanding: experimental models have greatly contributed to our comprehension of the underlying mechanisms in RH, including factors like sympathetic activation, endothelial dysfunction and structural vessel abnormalities. Secondly, for assessing treatment approaches: animal models have also played a crucial role in evaluating the potential effectiveness of diverse treatment approaches for RH. These encompass both pharmacological options, involving combinations of established drugs or novel pharmaceuticals, and non-pharmacological alternatives, which include surgical procedures like renal denervation, medical devices like baroreceptor stimulators, and lifestyle modifications. The most lacking component in translational research is the fact that there is no well-established animal model that perfectly replicates RH. Consequently, alternative strategies, including the combination of models, must be considered. What remains clear is that the development of animal models closely mimicking RH holds the promise of providing valuable insights into the essential mechanisms and responses necessary to combat or slow the global progression of RH.

Interventions through Art Therapy and Music Therapy in Autism Spectrum Disorder, ADHD, Language Disorders, and Learning Disabilities in Pediatric-Aged Children: A Systematic Review.

Traditional pharmacological treatments, although effective, often carry potential side effects, which positions art therapy and music therapy as promising non-pharmacological alternatives to alleviate symptoms and improve social, cognitive, and emotional skills without the associated risks. Through a review in the SCOPUS and WOS databases following the PRISMA protocol, a total of 80 articles were analyzed through a series of determined categories and subcategories of analysis. The aim of this study is to evaluate and synthesize the existing evidence on the efficacy and applicability of art therapy and music therapy in the treatment of children with autism spectrum disorder (ASD), hyperactivity disorder (HSDD), developmental language disorders, and language learning difficulties, identifying best practices and key areas for future research. Among the main findings is that art therapy and music therapy have a significant impact on symptomatology, behavior, and communication as well as social, cognitive, and emotional skills in the pediatric populations studied. These therapies are highly valued by the participants with a large majority recognizing their adaptability to different educational and clinical contexts. It is concluded that these therapies have a high potential as viable alternatives or complements to traditional pharmacological treatments, justifying their application and further study in broader therapeutic contexts.

Metabolome and transcriptome analysis reveal the effect of methyl jasmonate on phytosterol biosynthesis in Brassica napus

AbstractPhytosterols are a group of nonpharmacological alternatives to prevent or control dyslipidemias and cardiovascular disease. Increasing the phytosterol content in rapeseed oil is important to enhance daily phytosterol intake. However, the mechanisms of biosynthesis and regulation of phytosterol in rapeseed remain unclear. In this study, two representative rapeseed cultivars with extremely high (H286) and low (H174) phytosterol content were selected and treated with various concentrations (0.5−5.0 mM) of methyl jasmonate (MeJA). The results showed that treatment with 1 mM MeJA increased the phytosterol content of H174 and H286 by 17% and 27%, respectively. Based on the multiomics data, a gene‐phytosterol regulatory network was constructed. We deduced that MeJA down‐regulated the expression level of BnaA07.SCL15, BnaC05.MYB61, and BnaC03.AGL2, thereby promoting the phytosterol biosynthesis , and which were validated through the transient expression in tobacco. Notably, overexpression of Arabidopsis BnaA07.SCL15 exhibited a significant decrease in their phytosterol content. Additionally, an integrative analysis of the high‐resolution metabolome and transcriptome revealed that the accumulation patterns of 997 metabolites were highly correlated with their corresponding gene expression patterns. MeJA also significantly affected flavonoid biosynthesis, α‐linolenic acid metabolism, and amino acid metabolism. Furthermore, BnaA09.TT8 and BnaC09.TT8 were found to regulate of flavonoids. Overall, this study provides valuable insights into the phytosterol biosynthesis in rapeseed and offers a simple and effective approach for improving rapeseed quality.

Aromatherapy for the prevention of postoperative nausea and vomiting: A systematic review and meta-analysis.

Postoperative nausea and vomiting (PONV) are common complications following surgical procedures. While drug-based treatments are standard, there is increasing interest in nonpharmacological alternatives, such as aromatherapy, due to potential benefits and minimal side effects. This study aimed to assess the effectiveness of aromatherapy in preventing PONV. A comprehensive systematic review and meta-analysis were conducted using PubMed, Cochrane Library, EMBASE, and CINAHL databases for studies published up to May 2023. The included studies were randomized controlled trials (RCTs) and nonrandomized studies of interventions that examined the impact of aromatherapy on PONV. The risk of bias was assessed, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was employed to evaluate the certainty of the evidence. Eleven studies were selected for review, with eight RCTs included in the meta-analysis. Aromatherapy effectively reduced postoperative nausea severity (standardized mean difference [SMD]: -0.93, 95% confidence interval [CI]: -1.64 to -0.22; P = 0.010), but the reduction in vomiting episodes was not statistically significant (SMD: -0.81, 95% CI: -1.98-0.37; P = 0.180). Subgroup analysis indicated that ginger essence, lavender, and peppermint oils were particularly effective in managing postoperative nausea. However, due to significant statistical heterogeneity and potential biases in the studies, the results should be interpreted with caution. The certainty of the evidence, as evaluated by the GRADE approach, was low. Preliminary evidence supports the potential benefit of aromatherapy in reducing the severity of postoperative nausea. However, given the low certainty of current evidence, more rigorous and standardized research is needed. The safety, affordability, and potential benefits to patient comfort make aromatherapy a promising area for further research in postoperative care.

New perspectives on migraine treatment: a review of the mechanisms and effects of complementary and alternative therapies.

Migraine is a prevalent and disabling neurovascular disorder, with women being more susceptible, characterized by unilateral throbbing headache, often accompanied by nausea and vomiting, and often associated with various comorbidities such as brain and cardiovascular diseases, which can have a serious impact on quality of life. Although nonsteroidal anti-inflammatory drugs (NSAIDs) are the main first-line medications for the treatment of pain, long-term use often leads to side effects and drug addiction, which emphasizes the need to investigate alternative pain management strategies with fewer adverse effects. Complementary and alternative medicine is a viable pain intervention often used in conjunction with traditional medications, including acupuncture, herbs, moxibustion, transcutaneous electrical stimulation, bio-supplements, and acupressure, which offer non-pharmacological alternatives that are now viable pain management options. This review focuses on the mechanistic doctrine of migraine generation and the role and potential mechanisms of Complementary and Alternative Therapies (CAT) in the treatment of migraine, summarizes the research evidences for CAT as an adjunct or alternative to conventional therapies for migraine, and focuses on the potential of novel migraine therapies (calcitonin gene-related peptide (CGRP) antagonists and pituitary adenylyl cyclase-activating peptide (PACAP) antagonists) with the aim of evaluating CAT therapies as adjunctive or alternative therapies to conventional migraine treatment, thereby providing a broader perspective on migraine management and the design of treatment programs for more effective pain management.

Actualización en el tratamiento de la tricotilomanía

Trichotillomania (TTM) is an obsessive-compulsive disorder in which affected individuals recurrently pull-out hair from any region of the body, causing hair loss or alopecia. The management of TTM is a therapeutic challenge for dermatologists and consists of a combination of pharmacological and non-pharmacological alternatives. Cognitive-behavioral therapy has successfully been used to treat TTM. However, not all patients are willing to follow this treatment strategy. Unconventional support tools are proposed, such as electronic devices, internet therapies and microneedling. N-acetylcysteine and memantine are considered suitable first-line therapies thanks to their favorable safety and efficacy profile, low risk of adverse effects, and significant benefits. The use of other drugs, including fluoxetine, clomipramine, olanzapine, and naltrexone has limited evidence of variable efficacy. The present review illustrates the current treatment modalities for the management of TTM.

Correlation between depression, physical exercise and neurodegenerative diseases

Introduction: Depression is the most common mental disorder, affecting a significant percentage of the adult population. The disease is associated with many negative health consequences and is one of the leading causes of disability and inability to work worldwide. This neurological condition is commonly associated with neurodegenerative diseases such as Alzheimer's disease (AD), Parkinson's disease (PD) and Huntington's disease (HD). In recent decades, advancements have uncovered certain pathophysiological and molecular mechanisms underlying these disorders. These revelations suggest that, although they exhibit unique characteristics, there are notable parallels in the neurobiological changes associated with major depressive disorder (MDD) and the neurodegenerative processes in Alzheimer's disease, Parkinson's disease, and Huntington's disease. In this article the relevance of non-pharmacological therapies in the management of neurodegenerative diseases have been rising. Almost absent from side effects, non-pharmacological alternatives, including physical exercise have shown promising benefits. Aim of the study: The study aims to evaluate the association between depression symptoms and neurodegenerative diseases. Moreover, we indicate sport as a way to preserve and improve cognitive function, and to maintain a proper quality of life. Material and methods: We conducted a review of scientific publications published in the years 1998-2024 in English and Polish in the PubMed and Google Scholar databases. We used keywords such as "depression", "neurodegeneration” and “physical exercise”. Conclusions: Depression has been demonstrated to be a risk factor for neurodegenerative diseases and suggested to be a possible prodrome for them. However, sport can alleviate behavioral symptoms in neurodevelopmental disorders, like anxiety, depression, indifference and sleep disruptions.

Pharmacotherapy and noninvasive neurostimulation for neuropathic pain

Neuropathic pain poses a significant challenge due to its complex mechanisms, necessitating specific treatments. In recent decades, significant progress has been made in the clinical research of neuropathic pain, marking a shift from empirical strategies to evidence-based medicine in its management. This review outlines both pharmacological and non-pharmacological interventions. Antidepressants (tricyclic and serotonin-noradrenaline reuptake inhibitors), antiepileptics (gabapentin, pregabalin), and topical agents constitute the main pharmacological treatments. These approaches target peripheral or central mechanisms associated with neuropathic pain. Noninvasive neurostimulation, including transcutaneous electrical nerve stimulation (TENS) and repetitive transcranial magnetic stimulation (rTMS), provides non-pharmacological alternatives. However, challenges persist in effectively targeting existing medications and developing drugs that act on novel targets, necessitating innovative therapeutic strategies.

Mind-Body Training: A Plausible Strategy against Osteomuscular Chronic Pain-A Systematic Review with Meta-Analysis.

(1) Background: Chronic pain, which affects more than one in five adults worldwide, has a negative impact on the quality of life, limiting daily activities and generating absences from work. The aim of the present review is to analyze the efficacy of mind-body therapies as therapeutic strategies for patients with chronic pain. (2) Methods: A systematic review with a meta-analysis was carried out, searching PubMed, Scopus, and Web of Science databases using specific keywords. We selected studies that included mind-body therapies as the primary intervention for older adults with chronic pain. The methodological quality of the articles was assessed using the PEDro scale. (3) Results: Of the 861 studies identified, 11 were included in this review, all of which employed different mind-body therapies as an intervention. The selected studies measured chronic pain as the main variable. (4) Conclusions: This review highlights the value of mind-body exercises in reducing chronic pain in older adults, suggesting their integration as a non-pharmacological therapeutic alternative that improves the quality of life, promoting a holistic approach to pain management.

The Effect Of Carrot Juice (Daucus Carota L) On Reduce The Degree Of Dysmenorrhea In Adolescent Women At State High School 1 Sampit, Kotawaringin Timur Regency

During menstruation women sometimes experience pain, the nature and level of pain varies, depending on each woman's pain threshold. Excessive pain during menstruation is called dysmenorrhea and one of the treatments for dysmenorrhea is non-pharmacological. The purpose of this study was to analyze the effect of Carrot Juice (Daucus Carota L) on reducing the degree of dysmenorrhea pain in adolescent women at State High School 1 Sampit, East Kotawaringin Regency.The research design used was a pre-experimental design method with a pretest-posttest design using a cross-sectional approach. The sample in this study were 46 respondents with purposive sampling. The results of bivariate analysis using the Wilcoxon Test Statistical test with α 0.05.From the results of the study it was found that the majority of respondents experienced controlled severe pain before being given carrot juice, namely as many as 28 respondents (60.9%), Almost all respondents experienced moderate pain after being given carrot juice, namely as many as 36 respondents (78.3%). The results of statistical tests using the Wilcoxon test showed that p value = 0.000 &lt;α (0.05), which means that H0 is rejected, H1 is accepted. means the effect of Carrot Juice (Daucus Carota L) on Reducing the Degree of Dysmenorrhea Pain in adolescent women at State High School 1 Sampit, East Kotawaringin Regency.Provision of carrot juice (Daucus Carota L) is effective for reducing the degree of dysmenorrhoea pain in young women, so it is expected that schools and health workers will provide socialization to overcome dysmenorrhoea pain with non-pharmacological alternatives, namely using carrot juice.

Predictive Model of Anxiety and Depression Perception in Multiple Sclerosis Patients: Possible Implications for Clinical Treatment.

To establish a predictive model for the presence of anxiety and depression in MS patients, based on variables such as psychological well-being, functional activity, and prefrontal symptoms. Additionally, this study aimed to propose non-pharmacological therapeutic alternatives based on this model. A descriptive, observational, and cross-sectional study was conducted with a sample of 64 diagnosed MS patients who underwent functional and cognitive assessments using the following questionnaires and scales: Functional Activities Questionnaire (FAQ), Acceptance and Action Questionnaire (AAQ-II), Experiences Questionnaire (EQ), Self-Compassion Scale Short Form (SCS-SF), Beck Depression Inventory II (BDI-II), State-Trait Anxiety Inventory (STAI), and Prefrontal Symptoms Inventory (PSI). The model showed an excellent fit to the data and indicated that psychological well-being was the most significant predictor of the criteria (β = -0.83), followed by functional activity (β = -0.18) and prefrontal symptoms (β = 0.15). The latter two are negatively related to psychological well-being (β = -0.16 and β = -0.75, respectively). Low psychological well-being is the variable that most significantly predicts the presence of anxiety and depression in MS patients, followed by functional activity and prefrontal alterations. Interventions based on mindfulness and acceptance are recommended, along with nutritional interventions such as antioxidant-enriched ketogenic diets and moderate group physical exercise.

Role of Indian Classical Music in Treating Alzheimer’s Disease and Related Dementias

The prevalence of Alzheimer’s disease (AD) and Alzheimer’s disease related dementias (ADRD) is on rise all around the globe with limited treatment options. Current symptomatic pharmacological treatments are modestly effective and are associated with adverse side effects. Therefore, there is an increased interest in validating non-pharmacological alternatives to treat AD/ADRD. One of such alternatives is music therapy which has recently picked up an upsurge not only in treating mental disorders but also other disparities. Many systematic reviews and meta-analyses using PubMed/Medline, Web of Science, Scopus, Google Scholar, and Cochrane database searches have revealed that music-based interventions successfully improved mood, depression, anxiety, verbal fluency, gait/motor abnormalities, autobiographic and episodic memory, and cognition, in neurological disorders including AD/ADRD and other dementias. In that regard, targeted effects of Indian Classical Music (Raga) are worth deciphering. In contrast to general emotional upliftment induced by other musical genres, Raga has an ability to evoke specific emotions based on its defined notational structure arranged in a specific ascending/descending order, and these effects are further magnified when the Raga is sung/performed at a designated time of the day based on its circadian specificity. Ragas containing the predominance of major notes are known to activate default mode network via induction of dopaminergic pathways and evoke cheerful/ happy emotions, causing mind-wandering and self-referential mental activity. On the other hand, the Raga becomes incrementally sentimental as the proportion of minor notes increase in a Raga structure. Ragas can affect brain activity, emotions, and autonomic functions. This review elucidates enhanced therapeutic potential of Indian Classical Music (Raga) as an advanced music therapy, that has an ability to exert Raga-specific health-effects in a circadian-specific manner. Raga therapy may be an effective disease-modifying treatment for treating AD and other dementias.

The effect of physical exercise with cognitive training on inflammation and Alzheimer's disease biomarkers of Mild Cognitive Impairment patients

Physical exercise (PE) was proven crucial for cognitive health of both demented and cognitively intact individuals. Simultaneous cognitive training may augment PE beneficial effects in demented patients. However, it is still debatable how PE and/or cognitive training reflect on mild cognitive impairment (MCI) and pathological factors related to Alzheimer's disease, namely inflammatory cytokines interleukin (IL) 1 beta and 6, tumor necrosis factor alpha (TNF-α), amyloid beta (Αβ) peptides, total tau protein (t-tau) and tau phosphorylated at threonine 181 (p-tau181). In the current study, 74 MCI patients were allocated to three groups: non-intervention (Control), PE, and PE with cognitive training (Mixed). Blood serum was received at the Baseline and after the intervention (at 3 months). Levels of IL-1β, IL-6, TNF-α, Αβ42, Αβ40, tau and p-tau181 were determined with enzyme-linked immunosorbent assay. PE and Mixed interventions reduced the levels of IL-1β, IL-6 and of p-tau181. Augmented levels of Αβ42 and the ratio Αβ42/40, and reduced ratio p-tau181/Αβ42 were verified only in the PE group. Reduced levels of TNF-α, Αβ40 and t-tau were verified only at the Mixed group. In addition, correlation analyses provided a significant interrelation between the alleviation of inflammation and p-tau181/Αβ42 reduction in patients of the Mixed intervention. These results suggest the beneficiary effect of PE and cognitive training on the regulation of inflammation resulting in mitigation of AD-related blood biomarkers and urge for their employment as non-pharmacological alternatives for stalling the progression of dementia.

Virtual Reality for Decreasing Procedural Pain during Botulinum Toxin Injection Related to Spasticity Treatment in Adults: A Pilot Study.

Botulinum toxin injections are commonly used for the treatment of spasticity. However, injection procedures are associated with pain and procedural anxiety. While pharmacological approaches are commonly used to reduce these, innovative technology might be considered as a potential non-pharmacological alternative. Given this context, immersive virtual reality (VR) has shown effectiveness in the management of procedural pain. Our retrospective pilot study aimed to assess the potential added value of virtual reality in the management of pain and anxiety during intramuscular injections of botulinum toxin. Seventeen adult patients receiving botulinum toxin injections were included. A numerical rating scale was used to assess pain and anxiety during the injection procedure. The patients reported the pain experienced during previous injections without VR before injection and the pain experienced in the current procedure with VR after the end of the procedure. The level of satisfaction of VR experience, whether or not they agreed to reuse VR for the subsequent toxin botulinum injection, and whether or not they would recommend VR to other patients were assessed. The use of virtual reality led to a decrease of 1.8 pain-related points compared to the procedure without technology. No significant improvement in the level of anxiety was reported. Patients were very satisfied with their VR experiences (7.9 out of 10), and many would agree to reuse VR in their next injection procedure (88%) and to recommend the use of VR in other patients (100%). VR was useful for managing procedural pain related to botulinum toxin injection in adults, with a high level of satisfaction reported by the patients. VR should be considered as a valuable alternative to pharmacological approaches to manage procedural pain during botulinum toxin injection in adults.

Efficacy of the Enteroadsorbent Silicol®gel in Adults with Irritable Bowel Syndrome Subtypes IBS-D or Mixed: Observational Open-Label Study.

Irritable bowel syndrome (IBS) is a common chronic gut-brain interaction disorder with limited effective treatment options. Intestinal adsorbents have a high adsorption capacity for gut irritants and may provide nonpharmacological alternatives. This post marketing study is aimed at providing up-to-date evidence to support the safety and efficacy in normal use of an established medical device for IBS treatment. In this open-label, observational study, adults with IBS with predominant diarrhoea (IBS-D) or IBS with mixed bowel habits (IBS-M), according to Rome IV criteria, received 4 weeks of treatment with the enteroadsorbent Silicol®gel, a CE-certified, licenced, medical device containing colloidal silicic acid. Eligible participants were assessed at baseline (visit 1; in-clinic) and after 1 (visit 2; telephone), 2 (visit 3; telephone), and 4 (visit 4; in-clinic) weeks of treatment. The primary endpoint was the proportion of participants with an overall reduction in the IBS severity scoring system (IBS SSS) > 50, representing clinically meaningful improvement. Key secondary endpoints were a reduction in common IBS symptoms and improved quality of life (QoL). Among the 67 treated participants (IBS-D: 37; IBS-M: 30), 65 completed the study. At visit 4, 83.6% (56/67) of participants achieved a reduction in IBS SSS > 50. The mean (standard deviation [SD]) IBS SSS was 323.4 (55.7) at visit 1 and 160.3 (90.3) at visit 4 (overall change: -163.1 (101.7); 95% confidence interval [CI] 138.3, 187.9, p < 0.001). Compared with visit 1, significant reductions in the severity of all key IBS symptoms and overall improvement in QoL were observed at visit 4 (p < 0.001), with improvements observed from visits 1 and 2. In this open-label study of participants with IBS-D and IBS-M, Silicol®gel provided clinically significant improvement in IBS symptoms, demonstrating that enteroadsorbents may be clinically beneficial in this population.

Lessons from the Netherlands for Australia: cross-country comparison of trends in antidepressant dispensing 2013-2021 and contextual factors influencing prescribing.

There is concern internationally about increasing antidepressant use. Most antidepressants are prescribed in general practice. The aim of this study was to compare trends in antidepressant dispensing in Australia and the Netherlands over the 9years from 2013 to 2021, and to explore reasons for differences. A convergent mixed methods study including analysis of publicly available antidepressant dispensing data obtained from Australia's Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme and the Dutch Foundation for Pharmaceutical Statistics and a search of relevant literature to compare contextual factors influencing prescribing were undertaken. In 2013, antidepressant dispensing rates in Australia were nearly twice as high as those in the Netherlands (82.5 versus 44.3DDD/1000/day) and increased to be more than twice as high by 2021 (115.6 versus 48.8DDD/1000/day). Antidepressant dispensing increased by 40% in Australia over the nine study years, but by only 10% in the Netherlands. Our scan of the literature confirms that while population factors, health system structure, and clinical guideline recommendations are largely consistent across the two countries, a multifaceted approach in the Netherlands involving improved access to non-pharmacological alternatives, initiatives targeting safer antidepressant prescribing, and tight regulation of pharmaceutical industry influence on prescribers, has successfully curtailed increasing antidepressant use. Australia may learn from the Netherlands' approach to redress increasing antidepressant use.

GAMBARAN PENGGUNAAN COMPLEMENTARY ALTERNATIVE MEDICINE (CAM) PADA PASIEN HIPERTENSI DI WILAYAH KERJA PUSKESMAS BLAHBATUH II

Hypertension is an increase in a person's systolic blood pressure ≥ 140 mmHg and diastolic ≥ 90 mmHg. The importance of hypertension sufferers to control blood pressure to prevent cardiovascular risk, one of which is the non-pharmacological alternative of Complementary Alternative Medicine (CAM). This study aims to describe the use of CAM in hypertensive patients in the working area of ​​the Blahbatuh II Health Center. This research method is a non-experimental quantitative descriptive study with a cross-sectional method. The results of this study found that the most use of CAM for the treatment of hypertension in the working area of ​​the Blahbatuh II Health Center were women (59.6%), aged 56-65 years (51.4%), high school education (42.2%), most of them not working/household (33.9%), income ≤ Rp. 2,627,000 (39.4%), suffer from hypertension for 1-5 years (76.1%), have no family history of hypertension (56.9%), hypertension medication, namely amlodipine (52.3%), drinking schedule every day (45.9%). Respondents used CAM since diagnosis (66.1%), CAM was combined with conventional drugs (62.5%) and was recommended by the family (45.8%), the reason that using CAM was very trusting CAM (47.2%), and the reasons for not using CAM were the reasons doctors did not recommend (54.1%), felt a positive effect (94.4%) and were satisfied (94.4%) using CAM. The most common types of CAM were biological therapy in the form of herbs (56.9%), the frequency of using CAM once a day (45.8%), the types of plants used were celery and starfruit (19.5%), plant parts namely leaves (41.5%), the method of processing is boiled first (61%), with a dose of one glass (48.8%) and the use of herbal medicine is taken orally (80.5%). The conclusion of this study was that the sociodemographic characteristics of the use of CAM were mostly aged 56-65 years (51.4%), female sex (59.6%), last education SMK/SMA (42.2%), and the use of CAM was mostly used since suffering from hypertension as many (66.1%) of respondents with the most types of CAM namely biological therapy in the form of herbs (56.9%).