Traditional, Complementary And Alternative Medicine Research Articles

Utilization of Traditional Complementary and Alternative Medicine Across Ethnically Diverse Asian Americans.

We conducted an analysis to identify factors influencing the use of traditional complementary and alternative medicine (TCAM), with a particular emphasis on ethnic variations. Using the 2015 Asian American Quality of Life survey (N = 2,609), logistic regression analyses were performed, considering acculturation, health status, healthcare accessibility/utilization, and socio-demographic factors. Ethnicity, specifically being Chinese or Korean Americans, having chronic medical conditions, experiencing unmet healthcare needs, and having regular check-ups were significant predictors of TCAM use among Asian Americans as a whole. However, when we delved into sub-ethnic groups, different patterns were found. Among Vietnamese and Filipino Americans, having unmet healthcare needs emerged as the most prominent predictor of TCAM use. Furthermore, acculturation level and English proficiency were significant in predicting Vietnamese and Filipino Americans' TCAM use, with the direction varying by sub-ethnicity. Being old emerged as a predictor of TCAM use for Chinese, Indian, Korean, and 'other' Americans. Our findings underscore the importance of adopting an ethnically sensitive approach when addressing the healthcare needs of diverse Asian American populations.

Perspective of adults in Saudi Arabia toward complementary and alternative medicine use for autism spectrum disorder: a cross-sectional study

BackgroundAutism Spectrum Disorder (ASD) is a high-prevalence neurodevelopmental disorder characterized by communicational, social, and behavioral challenges. Complementary and alternative medicine (CAM) is a group of practices and products that fall outside the realm of conventional medicine practiced worldwide. Traditional CAM is a health practice that comes from a particular culture, such as the use of Zamzam water and black seeds in Saudi Arabia. CAM comprises widely utilized practices in Saudi Arabia for children of various ages and adults. In many cases, CAM is used to treat ASD. The aim of this study is to investigate the perspectives of adults in Saudi Arabia toward CAM for treating ASD.MethodsA cross-sectional study was conducted by distributing an online questionnaire to adults in different regions of Saudi Arabia.ResultsA total of 4,311 adults participated in this study; 66.8% were females and 33.2% were male. Half of the participants reported that they knew about ASD (54.7%). More than half of the participants indicated that CAM—including art therapy (69.0%), physical exercise (67.0%), and limiting the use of electronic (55.4%)—could help in ASD management. Around half of the respondents indicated a belief that traditional treatment cannot help in treating ASD (53.9%). Only 20.0% of the respondents thought that ASD could be entirely treated using CAM therapies. The most common source of knowledge about CAM was social media and the internet (58.6%).ConclusionsThe majority of participants in this study did not believe that ASD could be treated entirely using CAM. In addition, fewer than half of the participants believed that CAM therapies could improve different aspects of ASD, such as behavioral issues. The study highlighted the need for awareness among residents of Saudi Arabia regarding specific treatments for ASD.

How does evidence-based medicine training affect medical students' views on traditional, complementary, and alternative medicine and the conspiracy theories about COVID-19: a nationwide study.

It was aimed to explore the relationship between evidence-based medicine (EBM) training and medical students' views on traditional, complementary, and alternative medicine (TCAM) and their views on conspiracies about COVID-19. Medical students constitute the future workforce of primary health care services. The relationship between EBM training and their views on conspiracies about COVID-19 is critical to explore for providing a better primary health care. The relationship EBM training and medical students' views on TCAM is also important in this regard. This is a cross-sectional study. Turkish medical students were surveyed about EBM training, TCAM, and COVID-19 conspiracies. The electronic survey form consisted of five parts: Demographic characteristics, views and self-perceived knowledge about TCAM and the methods, views on the origin of SARS-COV-2, participation in EBM training, and views on TCAM training. A total of 49 medical schools provided response. Along with descriptive statistics, Chi-square test was utilized. Among 2577 participants, 24.0% of them believed SARS-COV-2 was artificially designed. The students who have participated in EBM training via both lecture and small group discussions have a less positive view on TCAM than both the students who have not participated in any EBM training (p < 0.05) and the students who participated in only-lectures (p < 0.05). There was a significant association between EBM training and whether believing COVID-19 (SARS-COV-2) has been designed purposefully by some people or it has emerged naturally χ2 (1) = 17.21 p < 0.001. The odds of thinking COVID-19 emerged naturally was 1.85 times higher (95% CI: 1.38-2.47) if the students have participated in EBM training via both lectures and small group discussions than if they have not participated in any EBM training. EBM training affects medical students in terms of beliefs on COVID-19 conspiracies.

Reasons for using traditional and complementary care by people living with HIV on antiretroviral therapy and association with interrupted care: a mixed methods study in Eswatini

The use of traditional, complementary, and alternative medicine (TCAM) can lead to delays and interruptions in the HIV continuum of care. This study explores reasons for TCAM use in people living with HIV on antiretroviral therapy (ART) in Eswatini and compares interrupted care between different types of TCAM users. Data were collected using surveys in the MaxART study (a test-and-treat trial) between 2014 and 2017 to assess the exposure, namely visiting a TCAM provider. Additionally, visit dates were retrieved from clinic records to assess the outcome, interrupted care. Open-ended questions were analysed with qualitative content analysis (n = 602) and closed questions with bivariable and multivariable analysis (n = 202). Out of 202 participants, 145 (72%) never used TCAM, 40 (20%) ever used, and 17 (8%) is currently using TCAM (diviners, herbalists, and religious healers). No differences in interrupted care were found comparing never (reference category), past (Odds Ratio: 1.31, 95% confidence interval: 0.63–2.72), and current users (1.34, 0.47–3.77), while adjusting for gender, time since HIV diagnosis, and time on ART. Contextual factors affecting the choice for TCAM were the influence of family, advice from the health facility, and religious beliefs. Individual factors include trust in biomedical care, type of illness, no need for additional care, and practical reasons such as financial means. In conclusion, individual and contextual factors influence the choice for TCAM. Interrupted care does not differ between never, past, and current users.

Healthcare Delivery in Nigeria: Traditional Medicine Practitioners Perspectives to Universal Health Coverage and Traditional Medicine Integration with Conventional Medicine

Introduction: The knowledge, attitude, and practice of Traditional Medicine Practitioners (TMPs) are key to achieving effective and sustainable integration of all forms of Traditional, Complementary and Alternative Medicine (TCAM) and health services towards Universal Health Coverage (UHC). In this study, the operational and psychological readiness of Traditional Medicine Practitioners towards integration with the conventional health system was examined by critically considering the various factors central to traditional medicine integration as recommended by the World Health Organisation (WHO) Traditional Medicine strategy (2014–2023).&#x0D; Methods: Paper based questionnaires were administered to Traditional medicine practitioners from three geo-political zones in Nigeria along with Key Informant Interviews. Qualitative – thematic and content analysis using both iterative and interpretative processes, and quantitative –descriptive and inferential analysis were done using statistical package for social sciences version 25.&#x0D; Results: A total of 337 respondents participated in the study ranging from 21-61 years of age. More than half (61.7%) were males. Most respondents 310 (92%) had one form of formal education out of which those with secondary education constitute over one-thirds, 121 (35.9%). Over three-quarter of the respondents, 290 (86.1%) were into general practice and over half of the respondents had between 11 – 20 years of experience as traditional medicine practitioners.  About two-thirds, 216 (64.1%) of study participants had no knowledge of what integration nor Universal Health Coverage 256, (76%) meant. However, many of the respondents (76.3%) had a good attitude towards integration. More than two-thirds of respondents, 241 (71.5%) claimed to keep patient records but only 157 (46.6%) kept written records.&#x0D; Conclusion: Traditional Medicine Practitioners in Nigeria have a positive outlook towards integration. Salient knowledge and practice gaps among them have been revealed. The study shows that regulatory and policy actions should be centred around the support, capacity building through trainings and conferences to disseminate information on scientific/technological advancements to improve their practice, and also to improve on existing policies and government activities.

Research trends in complementary and alternative treatments for insomnia over the past decade: A bibliometrics analysis.

Insomnia is the most common sleep disorder, with persistent insomnia being associated with greater risk and leading to a range of functional consequences that place a heavy burden on patients and healthcare systems. A weight of evidence has shown that complementary and alternative medicine (CAM) seems to have a positive effect on improving sleep. However, the research trends of CAM intervention for insomnia have not been studied systematically through bibliometrics. We searched the relevant literature over the past decade in the Web of Science Core Collection database on September 20, 2022 and used CiteSpace and gCLUTO to visually analyze and cluster countries, institutions, authors, journals and keywords. Through screening, 1655 papers were included. In the past decade, the number of articles published in this field shown an annual trend of growth, with explosive growth in 2020. The USA has the largest number of publications, the University of Hong Kong is the leading institution in this field, and the most cited journal is Sleep. Mental condition and quality of life in patients with insomnia, insomnia related to cancer, effect of mindfulness meditation, yoga and aromatherapy on insomnia and the psychiatric symptoms resulting from the COVID-19 pandemic are at the forefront of this field. In this study, bibliometrics and visualization analysis were performed on related studies on CAM intervention for insomnia. This will be the focus and development direction of insomnia treatment in the future to formulate structured treatment plans for traditional Chinese medicine-related CAM, validate large-scale clinical trials, solve cancer comorbidity insomnia and related psychiatric symptoms and deal with mental health-related insomnia after public health outbreaks.

A Review on the Acceptability of Use of Traditional, Complimentary, and Alternative Medicines in the Management of Hypertension

The objective of this study was to conduct a systematic review of published studies on the acceptability of the use of TCAM (Traditional, Complementary, and Alternative Medicine) in the management of hypertension. Hypertension as a long-term disease cannot be managed by drug therapy only, with that, a series of articles are included to provide evidence of how TCAM alleviates the condition of people suffering from hypertension. TCAM as the totality of expertise based on theories, concepts, and experiences in treating several conditions is essential in the healthcare system. In search of existing literature, the following databases are used: PubMed/Medline, Google Scholar, Science Direct, and Cochrane. Literatures retrieved were classified and analyzed to evaluate the acceptability of the use of TCAM on the management of hypertension. Their health improves when they use traditional medicinal plants. However, a few people reported dizziness, stomach discomfort, burning, an unpleasant feeling, a drop in blood pressure and sugar, and a few persons were unsure. While Yoga, Meditation, Relaxation Techniques, Acupressure, and Acupuncture are among the most popular alternative medicine interventions that have been shown to lower blood pressure despite this evidence, it has not been proved clearly that they may be used to manage hypertension. Furthermore, the significant reduction in systolic and diastolic blood pressure of hypertensive patients from the use of complementary and alternative interventions in the various articles reviewed can contribute positively to the reduction of blood pressure. Results found that TCAM has long been utilized to manage hypertension and the use of some TCAMs can be an acceptable means to manage hypertension, according to the studies.

Prevalence of traditional, complementary, and alternative medicine (TCAM) among adult cancer patients in Malawi.

The objective of this study is to document the prevalence of traditional, complementary, and alternative medicine (TCAM) use by adult cancer patients at a national teaching hospital in Malawi. We aim to document the products/therapies used, the reason for use, as well as patient-reported satisfaction with TCAM practitioners and modalities. We conducted investigator-administered interviews with adult cancer patients presenting to the Kamuzu Central Hospital (KCH) Cancer Clinic in Lilongwe, Malawi between January and July 2018. The KCH is a national teaching hospital in the capital of Lilongwe, which serves patients with cancer from the northern half of Malawi. Descriptive statistics were used to describe TCAM use and logistic regression was applied to identify predictors of TCAM. A total of 263 participants completed the survey, of which 70% (n = 183) were female and average age was 45 (SD 14) years old. The prevalence of overall TCAM use was 84% (n = 222), and 60% (n = 157) of participants reported combining TCAM with conventional cancer treatment. The majority of patients used TCAM to directly treat their cancer versus for symptom management. Patients reported using faith-based healing (64%, n = 168), herbal medicine (56%, n = 148), diet change (46%, n = 120), and vitamins/minerals (23%, n = 61). Participants reported the highest satisfaction for physicians among practitioners and diet change for modalities. Female gender was found to be a predictor of TCAM with conventional treatment use, no other significant predictors were observed. There is a high prevalence of TCAM use among an adult population with cancer in Malawi, and a wide variety in the TCAM modalities used among patients. Additional studies are needed to identify risks and benefits of TCAM use to assist with policy and public health, patient safety, and holistically address the global burden of cancer.

Establishment of a Digital Database for Traditional Herbal Medicines in Kenya

Traditional complementary and alternative medicine (TCAM) is widely used and accepted worldwide. In Africa, the use of TCAM is increasing, with a few countries having developed digital databases for their traditional medicines. Lack of such databases has led to the tendency of researchers and herbalists to return to nature in search of new drugs. However, going back to nature searching for TCAM is a challenge because most herbalists are less educated and are advanced in age to continuously and accurately provide information on medicinal plants. These pose a risk of forever losing the rich ethnomedical knowledge, hence, the need to develop a freely accessible, national digital database with medicinal plants. Creating such a comprehensive digital database will involve collecting necessary data through theses, online research articles, and published books. The database will contain vital information on botanical and vernacular names of medicinal plants in Kenya, parts of plants used to treat diseases, therapeutic uses, the phytochemical compounds, toxicity, and the target proteins/genes. Kenya, therefore, needs to develop a national, freely accessible digital database for its medicinal plants. The database will provide vital information on TCAM for health workers, scientists, herbalists, policy-makers, and educators in Kenya and worldwide to hasten drug discovery and development.

Usage of Traditional, Complementary and Alternative Medicine and Related Factors among Patients Receiving Healthcare in Lesotho

Background: The use of Traditional, Complementary and Alternative Medicine (TCAM) is becoming apparent among many populations, particularly those suffering from chronic illnesses. Although this is a concern to clinicians, especially on safety and potential health risks, there is a paucity of data on TCAM usage and related factors among patients receiving healthcare in Lesotho. Objective: To determine the prevalence of TCAM usage and associated factors among patients receiving healthcare in a health facility in Lesotho. Methods: A cross-sectional study was conducted among 336 patients receiving healthcare in the Maseru district, Lesotho. A validated questionnaire was used to collect data on demographic and lifestyle factors, disease and treatment profile, treatment challenges, and TCAM usage, reasons/purpose, disclosure, healing system, duration, costs, sources and types. Multiple logistic regression analysis was used to ascertain any relationships with TCAM usage. Results: The response rate was 98%. The mean age of participants was 51±16years. Unemployment (63%) was high and, over half of the patients (59%) attained primary school education. Patients were mostly on treatment for sexually transmitted infections (42%), non-communicable diseases (30%) and comorbidities (19%), with 98% taking prescribed medication. TCAM usage was 15% with Traditional Herbal Medicine (THM) being the most widely used. Common THM were Dicoma Anomala, Eriocephalus Punctulatus, Aloiampelos Striatula, Artemisia Afra and Allium Sativum, obtained from the traditional healers (53%), followed by relative/friends (16%), pharmacists (13%), open market (12%), and accessed at low costs. TCAM was used to treat infectious (23%) and non-infectious (77%) diseases, but disclosure (7%) to healthcare workers was low. Multivariate analysis showed that TCAM usage was associated with self-employment AOR=6.3, 95%CI; 2.57-15.21, and being a student AOR=3.6, 95%CI; 0.99–12.71. Conclusion: THM was the most widespread type of TCAM among the study population in Lesotho. Prospective studies on TCAM usage are necessary to inform proper practice and safety in Lesotho.

“Sex is supposed to be naturally more pleasurable”: Healers as providers of holistic sexual and reproductive healthcare in Uganda

Global health researchers often approach Traditional, Complementary, and Alternative Medicine (TCAM) from a health efficacy perspective, asking whether the presence of plural medical systems helps or hinders the uptake of biomedicine. Medical anthropologists, by contrast, typically emphasize how plural medical systems encourage us to rethink health ontologies—that is, who and what comes to constitute the experience of health and illness, and through which practices. Building on both approaches, we explore the role of “healers,” a term we use to encompass several different kinds of TCAM providers, in the sexual and reproductive healthcare (SRH) of young people from southcentral Uganda, a region well known as an HIV/AIDS epicenter. Drawing from ethnographic data, we describe three reasons that young people seek SRH from healers. First, they associate stigma, scarcity, and high costs with biomedical SRH. Second, healers work across biomedical and non-biomedical therapeutic divides, prescribing herbs for sexually transmitted infections while simultaneously referring clients to biomedical HIV clinics. Third, healers provide counseling focused on pleasurable and economically-motivated sex. Because these therapies diverge from international and national HIV prevention messaging that frames non-marital and transactional sex in terms of danger and disease, healers’ holistic approach to SRH may help to reconstitute the meaning, practice, and experience of “sexual health” in contemporary Uganda. This has important implications for improving global SRH programs and for understanding the continued appeal of TCAM more generally.

Mamografi Ünitesine Başvuran Kadınlarda Geleneksel, Tamamlayıcı ve Alternatif Tıp Kullanımı: Tanımlayıcı Bir Araştırma

Objective: The study aimed to determine the factors associated with the use of traditional, complementary and alternative medicine (TCAM) methods of women who applied to a mammography unit. Material and Methods: The descriptive study was carried out on 198 volunteer female patients. The data were obtained through a questionnaire form created by the researchers. Chi-square test was used in statistical analyses and p values lower than 0.05 were considered statistically significant. The required local ethics committee approval was obtained. Results: The mean age of the patients was 49.2±12.8 years, 29.3% applied for mammography screening and 70.7% applied for a control examination. The frequency of those who used any TCAM method was 47.5%. At the time of their initial diagnosis, 33% of the patients used TCAM during the treatment process. When comparing the sociodemographic features, reasons for admission, diagnosis times, and treatment methods of the used and non-used TCAM classes, no statistically significant differences were observed (p>0.05). And 60.0% of breast cancer patients who used TCAM and 81.3% of those with fibroadenome or breast cysts did not share information with their physicians that they used TCAM. Conclusion: Regardless of sociodemographic characteristics or breast disease diagnosis, it was determined that approximately half of the women who applied to the mammography unit used a TCAM method at any time in their lives. Considering that some TCAM methods can lead to diagnosis and treatment delays, we think that physicians questioning the use of TCAM in their patients should become a routine part of the examination.

Utilization of traditional medicine in the treatment of ailments among aged people in Ughelli community of Delta State

Traditional, complementary and alternative medicine (TCAM) refers to a set of healthcare practices (indigenous or imported) that are delivered outside of the mainstream (orthodox) healthcare system. The broad objective of this study was to investigate the use of traditional medicine in the treatment of ailments among aged people in Ughelli Community of Delta State, Nigeria. The study comprised of 241 subjects (121 males and 120 females) of about 40+ years who were resident in Ughelli community. First, a self-administered, open and close questionnaire was carefully structured, validated and issued to a cross section of selected subjects from within the study area. The instrument obtained the socio-demographic records of the subjects, alongside their knowledge on traditional medicine, attitudes towards, as well as practices towards traditional medicine. Information on the source, benefit, adverse effects and frequently used traditional medicines were also collected from participants, while leaving them with multiple responses in the open-ended questions. Following data collection, Results were subjected through the Statistical Package for Social Sciences (SPSS version 25), using the Chi-square test at a 95% confidence interval. One-way analysis of variance (ANOVA) was also used to compare the differences in means between groups, while setting a p value less than 0.05 as statistically significant. From our observation, an average of 98 subjects strongly agreed to their knowledge of the effectiveness of traditional medicines in the treatments of ailments. This number was of significant increase in comparison with about 76 subjects who were not sure in their response on the effectiveness of traditional medicines over orthodox in the study area. In addition, this negates the total number of sampled respondents (15%) who posited to disagree in support of the non-effectiveness of traditional medicines over its effectiveness. Also, a great percentage (36%) responses agreed that drinking is a far effecting and popular route of administering traditional medicines than others, while about 27% strongly agreed to this; even though a greater proportion of responses were not sure of the topical routes of applying traditional medicines.

The dynamics of TCAM integration in the Indian public health system: Medical dominance, countervailing power and co-optation

Hierarchies of power among healthcare professionals are well documented, nonetheless, power remains neglected, understudied and under-theorised in health systems analysis and policy discussions, especially in the domain of Traditional, Complementary and Alternative Medicine (TCAM). Sociological and public health scholarship has documented the persistence of medical dominance in the health system, theorised as the limitation, subordination, exclusion and incorporation of other professions. This paper explores how interprofessional power dynamics shape the integration of TCAM into Indian primary healthcare centres, as part of a nationwide policy of TCAM integration and medical pluralism implemented since 2005. We conducted interviews (n = 37) with health system administrators, nurses, pharmacists, TCAM and biomedicine doctors, and observed day-to-day activities of primary healthcare centres for six months in Odisha state, India. Thematic analysis enabled the identification of themes and exploration of sub-themes. The analysis revealed multilayered forms of medical dominance within the primary healthcare system and identified multiple sites where everyday power is mobilised. Biomedicine practitioners exercised authoritative power and restricted TCAM doctors' access to facility-level resources, i.e. financial and workforce support, which inhibited the integration policy implementation. Significantly, TCAM doctors were ‘ordered’ to practice biomedicine at primary healthcare centres, which was beyond the scope of the integration policy. However, TCAM doctors were also able to exercise countervailing power in their day-to-day activities in the primary healthcare centres and sought to assist patients' health behaviour change through their authoritative knowledge about ‘how to live a healthy life’. The health system actors involved in policy implementation hold a range of forms of power specific to the circumstances, influencing the integration processes. We explain these dynamics in relation to existing theories of medical dominance and countervailing power, while introducing a previously unreported dimension of dominance: ‘co-optation’, which enrols TCAM practitioners in the practice of biomedicine.

Willingness to pay for traditional, complementary and alternative medicine (TCAM) among Malaysian adults

Purpose Health plays a crucial role in the daily lives and supporting health is the important role of medicine. With the availability of traditional, complementary and alternative medicine (TCAM), the demands and willingness to pay among users are increasing. Hence, this study aims to determine the psychological factors influencing the willingness to pay for TCAM among Malaysian adults. Design/methodology/approach In total, 300 completed self-administered questionnaires were collected from Malaysian adults using a purposive sampling method through intercepts at public health-care facilities. A structural equation modelling approach using partial least square was used to test the hypotheses. Findings The findings show that attitude, subjective norms, perceived price and knowledge have a significant impact on willingness to pay for TCAM. Surprisingly, there was no relationship found between perceived behavioural control and health consciousness on willingness to pay for TCAM. Originality/value The findings of this study are expected to provide better insights into TCAM use among Malaysian adults. The results are also important to encourage health-care institutions and practitioners to educate the general public on the safety of TCAM to ensure more health benefits to the users.

Prevalence of the use of traditional complementary and alternative medicine amongst cancer patients in a tertiary care center in Kerala, India

BackgroundUnmet needs of cancer patients prompt them to seek care from Traditional, Complementary and Alternative Medicine (TCAM) practitioners. ObjectiveTo investigate the prevalence of TCAM use in a multi-specialty tertiary cancer center in South India. Materials and methodsA cross-sectional survey of cancer patients who used TCAM during the study period. The patients were recruited based on covenience sampling method. Result320 cancer patients were approached, out of which 279 (87.2%) patients responded, and the prevalence of TCAM use was 34.4%. Home remedies (36%) figure prominently, with family advice (40%) being the primary influence for the TCAM use. The key expectation was an improvement in the quality of life (49%). TCAM use was pronounced during the chemotherapy phase (50%). Most patients (76%) using TCAM reported satisfaction with the treatment. Majority of the patients did not disclose concomitant use of TCAM to their treating physicians (71%). ConclusionTCAM use by cancer patients is prevalent in Kerala. The study results point towards a need for large scale surveys, implementation of pharmacovigilance, patient education and research to identify and integrate TCAM interventions in cancer care that are safe and have beneficial effects.

Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review

IntroductionStarting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor....

Integrative and complementary practices: interest of the academic community and challenges of medical education

Abstract: Introduction: Traditional Complementary and Alternative Medicine (TCAM) encompass therapeutic resources of complex medical systems from different medical rationalities. This field of practice has gained greater visibility in recent times, with the increase in demand for health care that prioritizes a more comprehensive approach of human beings, encouraging the health professionals themselves to seek better training. Objective: To evaluate the interest, the degree of knowledge and the attitude of students and teachers of the medical course towards the TCAM and the challenges for their effective teaching. Method: This is a cross-sectional, descriptive study with a quantitative approach, which was carried out with 214 individuals, 21 of which were teachers and 193 students attending the first to the twelfth semesters of the medical course at a health education institution in Recife-PE. An online survey was used to assess the study participants regarding their learning sources and the level of interest on this topic, as well as the Portuguese version of the Integrative Medicine Attitude Questionnaire (IMAQ). The data were submitted to descriptive statistical analysis (frequency and percentage), using software R, version 3.4.3. and LibreOffice. Result: Among the study participants, 57.14% of teachers and 35.42% of students were aware of the Nacional TCAM Policy (PNPIC, Política Nacional de Práticas Integrativas e Complementares), 85.71% of the teachers and 91.7% of students considered TCAM to be crucial for Brazilian Unified Health System (SUS). Most considered the teaching of TCAM an important subject for the undergraduate medical course (90.48% of teachers and 89.58% of students). The best known practices were yoga, phytotherapy and TCM/acupuncture and there was greater interest to learn yoga and TCM/acupuncture. Conclusion: A large number of students and teachers have never had contact with TCAM. However, most are willing to recommend them to patients and family members and are willing to learn about the topic. Thus, it is recommended that more studies be performed on this topic and that it can corroborate for their inclusion in health courses’ curriculum.

Prevalence, Determinants and Outcomes of Traditional, Complementary and Alternative Medicine Use for Hypertension in Low-Income Households in Malaysia and the Philippines

Background: Traditional, complementary and alternative medicine (TCAM) is widely used for a range of conditions, especially in Southeast Asia. This study examines the prevalence and characteristics of TCAM use for hypertension, its determinants, and its association with hypertension management outcomes and wellbeing among low-income adults in Malaysia and the Philippines. Methods: We analysed cross-sectional data from 946 randomly selected adults diagnosed with hypertension (495 in Malaysia, 451 in the Philippines) from low-income communities. We compared the prevalence and characteristics of TCAM use between countries and used multi-level, mixed-effects regression to estimate associations between TCAM use and its determinants, five hypertension management outcomes and wellbeing. Findings: The prevalence of TCAM use was higher in the Philippines than in Malaysia (18·8% vs 8·8%, p<0·001). Biologically-based modalities, e.g. herbal remedies, were the most common type of TCAM used in both countries. Belief that TCAM is effective for hypertension was a positive predictor of TCAM use while belief in Western medicine was a negative predictor. TCAM use was not associated with current use of medications for hypertension, self-reported medication adherence, blood pressure level and control, or wellbeing in either country. Interpretation: A small, but significant, proportion of individuals living in low-income communities in Malaysia and the Philippines use TCAM to manage their hypertension. Recognising that their patients may be engaging in TCAM will enable health care providers to deliver better, more patient-centred care. Funding: This study was supported by a grant from the Wellcome Trust/Newton Fund-MRC Humanities & Social Science Collaborative Award scheme (200346/Z/15/Z). Declaration of Interest: LMP-V, BP conceived and led the analysis and writing of this paper, contributing equally. LMP-V, BP, DB, FAM, AR, MLS, ALD, KY, MM designed, initiated and coordinated the RESPOND study. All authors contributed to study implementation, interpretation of results, critical review and revision all drafts, and approved the final version of this manuscript. All authors agree to be accountable for all aspects of the work. Ethical Approval: Ethical approval for this study was granted by the Observational Research Ethics Committee at the London School of Hygiene & Tropical Medicine (Ref: 12214) and the Research Ethics Boards at the Universiti Putra Malaysia (JKEUPM-2017-229) and the University of the Philippines Manila (UPMREB-2017-481-01). All participants gave informed consent.

Integrative and complementary practices: interest of the academic community and challenges of medical education

Abstract: Introduction: Traditional Complementary and Alternative Medicine (TCAM) encompass therapeutic resources of complex medical systems from different medical rationalities. This field of practice has gained greater visibility in recent times, with the increase in demand for health care that prioritizes a more comprehensive approach of human beings, encouraging the health professionals themselves to seek better training. Objective: To evaluate the interest, the degree of knowledge and the attitude of students and teachers of the medical course towards the TCAM and the challenges for their effective teaching. Method: This is a cross-sectional, descriptive study with a quantitative approach, which was carried out with 214 individuals, 21 of which were teachers and 193 students attending the first to the twelfth semesters of the medical course at a health education institution in Recife-PE. An online survey was used to assess the study participants regarding their learning sources and the level of interest on this topic, as well as the Portuguese version of the Integrative Medicine Attitude Questionnaire (IMAQ). The data were submitted to descriptive statistical analysis (frequency and percentage), using software R, version 3.4.3. and LibreOffice. Result: Among the study participants, 57.14% of teachers and 35.42% of students were aware of the Nacional TCAM Policy (PNPIC, Política Nacional de Práticas Integrativas e Complementares), 85.71% of the teachers and 91.7% of students considered TCAM to be crucial for Brazilian Unified Health System (SUS). Most considered the teaching of TCAM an important subject for the undergraduate medical course (90.48% of teachers and 89.58% of students). The best known practices were yoga, phytotherapy and TCM/acupuncture and there was greater interest to learn yoga and TCM/acupuncture. Conclusion: A large number of students and teachers have never had contact with TCAM. However, most are willing to recommend them to patients and family members and are willing to learn about the topic. Thus, it is recommended that more studies be performed on this topic and that it can corroborate for their inclusion in health courses’ curriculum.