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1.  537 Use of Complementary and Alternative Medicines by Children Suffering from Asthma at Mangalore, India 
Background
Patients with chronic diseases including asthma, have a greater tendency to use Complementary and alternative medicine (CAM) as they are more concerned about the adverse effects of conventional medicine, dissatisfaction with their medical care, as well as a subjective feeling of health improvement with use of CAM. The aim of this study was to determine the prevalence of the use of CAM, reasons for use of CAM, and sources of information about CAM among paediatric asthmatic patients in outpatient department and urban health centre.
Methods
Following approval from Institutional Ethics committee, the data for this cross-sectional study was collected from parents of 125 paediatric patients diagnosed with asthma for more than a year waiting to see the doctor in the outpatient clinic in teaching hospitals and urban health centre of Kasturba Medical College, Mangalore, India during the period from March 2010 to September 2010. A pre-tested self-administered questionnaire in Kannada was distributed to the parents, the purpose of the study was explained, assurance of anonymity was conveyed, and emphasized that the patient's decision to complete or decline to complete the survey would not affect his/her healthcare quality in any way. Written informed consent was obtained from the participants.
Results
Data regarding 125 children with a mean age of 9.06 years were collected, the majority were male (n = 76, 60.8%). The prevalence of ever-CAM use was 72.8% (n = 91). Sixty-three males (69.2%) used CAM compared to 28 females (30.8%) (P < 0.001). Fifty-six (61.5%) CAM users had not discussed use of CAM with their doctors. The main reason of non-disclosure was "the doctor never asked" (n = 59, 64.8%), and the main sources of information about CAM were family and relatives (n = 45, 49.4%). The majority of asthmatic patients used Ayurvedic medicines and mixtures (n = 35, 38.5%), foods (n = 18, 19.7%) and herbs (n = 16, 17.6%). About 76% (n = 69) of asthmatic patients perceived CAM as good for their disease management.
Conclusions
Use of CAM among asthmatic patients is relatively high, particularly among females. The majority of asthmatic patients valued the use of CAM. Health education of asthmatic patients about CAM is highly recommended.
doi:10.1097/01.WOX.0000411652.02689.ca
PMCID: PMC3513180
2.  Use of complementary and alternative medicine in children with asthma 
BACKGROUND:
Because of the potential risk of interaction with, and underuse of, conventional medications, it is important to document the prevalence of the use of complementary and alternative medicines (CAMs) in asthmatic children.
OBJECTIVE:
To ascertain the prevalence and type of CAMs, and to identify factors associated with their use.
METHODS:
A cross-sectional survey of children who presented to the Asthma Centre of The Montreal Children’s Hospital (Montreal, Quebec) between 1999 and 2007 was conducted. At the initial consultation, parents completed a questionnaire inquiring, in part, about CAM use. Computerized health records provided information regarding patient characteristics and their condition.
RESULTS:
The median age of the 2027 children surveyed was 6.1 years (interquartile range 3.3 to 10.5 years); 58% were male and 59% of children had persistent asthma. The prevalence of CAM use was 13% (95% CI 12% to 15%). Supplemental vitamins (24%), homeopathy (18%) and acupuncture (11%) were the most commonly reported CAMs. Multivariable logistic regression analysis confirmed the association of CAM use with age younger than six years (OR 1.86; 95% CI 1.20 to 2.96), Asian ethnicity (OR 1.89; 95% CI 1.01 to 3.52), episodic asthma (OR 1.88; 95% CI 1.08 to 3.28) and poor asthma control (OR 1.98; 95% CI 1.80 to 3.31).
CONCLUSION:
The prevalence of reported CAM use among Quebec children with asthma remained modest (13%), with vitamins, homeopathy and acupuncture being the most popular modalities. CAM use was associated with preschool age, Asian ethnicity, episodic asthma and poor asthma control.
PMCID: PMC2933775  PMID: 20808977
Alternative medicine; Asthma; Complementary medicine; Determinants; Pediatric; Prevalence
3.  Complementary and alternative medicine use by patients chronically infected with hepatitis C virus 
Complementary and alternative medicine (CAM) is becoming increasingly popular in North America. The use of CAM is also popular in patients with chronic liver disease but is not well documented. The extent of use of CAM in chronic hepatitis C virus (HCV) infected patients was determined, and the demographic and clinical data between users and nonusers of CAM was compared.
Seventy-six patients (30% female) with chronic HCV were interviewed. The mean age was 43±8 years. Current use of CAM for HCV was reported by 35 of 76 patients (46%). Eighteen of 76 patients within this group used herbal supplements (24%). The most commonly used herb was Silybum marianum (milk thistle), reported by 10 of 76 patients (13.2%). Commonly reported benefits of CAM use included reduction in fatigue, boost in the immune system and improved gastrointestinal function. No adverse effects of CAM use were reported. In the present study, four of 18 patients (22%) with chronic liver disease taking herbal therapies were on herbs that increased bleeding time.
The use of CAM in chronic HCV patients is significant. Patients should be asked specifically about their use of CAM. CAM use may have implications affecting conventional treatment and management of HCV.
PMCID: PMC2657989  PMID: 17853954
Ambulatory care; Complementary and alternative medicine; Herbal therapy; Milk thistle; Nova Scotia; Nurse practitioner; Questionnaire; Viral hepatitis
4.  Complementary alternative medicine use among patients with type 2 diabetes mellitus in the primary care setting: a cross-sectional study in Malaysia 
Background
Limited study on the use of complementary alternative medicine (CAM) among patients with diabetes mellitus (DM), particularly in primary -care settings. This study seeks to understand the prevalence, types, expenditures, attitudes, beliefs, and perceptions of CAM use among patients with DM visiting outpatient primary care clinics.
Methods
This is a descriptive, cross-sectional study of 240 diabetic patients. CAM is defined as a group of diverse medical and healthcare systems, practices, and products that are not generally considered part of conventional Western medicine. Data analysis was done using SPSS v. 19 and multiple logistic regressions were used to identify predictors of CAM use.
Results
The prevalence of CAM use was 62.5 percent. Female were 1.8 times more likely than male in using CAM. Malays (75%) were the most frequent users, followed Indians (18%) and Chinese (6%). Biological therapy (50.0%) were the most widely used, followed by manipulative-body based systems (9.2%), energy system (8.8%), alternative medicine systems (4.6%) and mind-body system (1.7%). In biological therapy, a total of 30.4 percent, 24.2 percent, 13.3 percent, and 7.9 percent of diabetic patients consumed bitter gourd (Momordica Charantia), followed by Misai Kucing (Orthosiphon Stamineus Benth), garlic (Allium Sativum), and Sabah snake grass (Clinacanthus Nutans Lindau) respectively. The mean of the expenditure on CAM usage was RM 52.8 ± 101.9 (US $16.9 ± 32.5) per month. According to multiple logistic regression analyses, being Muslim (OR 5.258, 95 percent CI 2.952-9.368) had significant positive association with CAM use.
Conclusions
The prevalence of CAM use was high among diabetics. Islam faith is predictor for CAM use among Type 2 DM patients. The most-common herbs used were bitter gourd (Momordica Charantia) and Misai Kucing (Orthosiphon Stamineus, Benth). Further studies on the anti-glycemic activity of the isolated compound may be needed in the future.
doi:10.1186/1472-6882-13-148
PMCID: PMC3701537  PMID: 23802882
Complementary alternative medicine; Diabetes mellitus; Primary care; Malaysia; Prevalence
5.  Frequency of complementary and alternative medicine utilization in hypertensive patients attending an urban tertiary care centre in Nigeria 
Background
To study the frequency and pattern of use of complementary and alternative medicine (CAM) in patients with essential hypertension attending a tertiary hypertension clinic.
Methods
Two hundred and twenty-five consecutive hypertensive patients attending the hypertension clinic of the Lagos University Teaching Hospital over a 3-month period were interviewed. Socio-demographic data, duration of hypertension, clinic attendance, current blood pressure, and compliance to conventional medications was documented. CAM utilization was explored using both structured and open-ended questions.
Results
There were 90 (40%) male and 135 (60%) female patients with mean age ± SD overall was 55.1 ± 12.4 years. 88 (39.1%) of the respondents used CAM. Herbal products were the most commonly used CAM type. Amongst the CAM users, the most common herbal product used was garlic (69.3%). Others were native herbs (25%), ginger (23.9%), bitter leaf (Vernonia amygdalina) (9.1%), and aloe vera (4.5%). 2.5% used spiritual therapy. There was no difference in the clinical characteristics, socio-economic status, and blood pressure control of CAM users and non-users. Patients who utilized CAM had higher BMI compared with those who did not, but the difference was not statistically significant (mean BMI ± SD of 29.1 ± 5.6 vs 27.1 ± 5.9 kg/m2; P = 0.05).
Conclusion
A significant proportion of hypertensive patients attending our tertiary facility and receiving conventional treatment also use CAM therapies. Clinicians need to be aware of this practice, understand the rationale for this health-seeking behaviour, proactively enquire about their use, and counsel patients regarding the potential of some of the therapies for adverse reactions and drug interactions.
doi:10.1186/1472-6882-7-30
PMCID: PMC2045097  PMID: 17903257
6.  Characteristics of users and implications for the use of complementary and alternative medicine in Ghanaian cancer patients undergoing radiotherapy and chemotherapy: a cross- sectional study 
Background
There is widespread use of Complementary and Alternative Medicine (CAM) in Ghana, driven by cultural consideration and paradigm to disease causation. Whether there is concurrent use of conventional medicine and CAM in cancer patients is unknown. This study investigates the prevalence, pattern and predictors of CAM use in cancer patients. Overlapping toxicity, sources of information, and whether users inform their doctor about CAM use is examined.
Method
Cross-sectional study using a questionnaire administered to cancer patients, who were receiving radiotherapy and or chemotherapy or had recently completed treatment at a single institution was used.
Results
Ninety eight patients participated in the study with a mean age of 55.5 (18–89), made up of 51% females. Married individuals formed 56% of the respondents, whilst 49% had either secondary or tertiary education. Head and neck cancer patients were 15.3%, breast (21.4%), abdomen/pelvic cancers constituted (52%).Seventy seven (78.6%) patients received radiotherapy only, 16.3% received radiation and chemotherapy and 5.3% had chemotherapy only.
Ninety five patients were diagnosed of cancer within the past 24 months,73.5% were CAM users as follows; massage(66.3%), herbal(59.2%), mega vitamins(55.1%), Chinese medicine(53.1%),and prayer(42.9%). Sixty eight percent were treated with curative intent. Overlapping toxicity was reported. Majority (83.3%) of users had not informed their doctor about CAM use.
On univariate analysis, female (p=0.004) and palliative patients, p=0.032 were more likely to be CAM users. Multivariate analysis identified female (p<0.01), as significant for use, whilst head and neck site was significant for non use (p<0.028). Young, married and highly educated individuals are more likely to use CAM.
Friends and Media are the main sources of information on CAM. There was increase in CAM use after the diagnosis of cancer mainly for Chinese Medicine and vitamins.
Conclusion
There is high CAM usage among Cancer patients, comparable to use in the general population, there is concurrent use of CAM and conventional medicine with reported overlapping toxicity but without informing Oncologist about use. Women and palliative patients are more likely to use CAM. Doctor patient communication on herbal-radiotherapy and drug treatment interaction needs to be strengthened. Standardization and regulation of CAM use is paramount.
doi:10.1186/1472-6882-13-16
PMCID: PMC3565863  PMID: 23331546
Complementary; Alternative; Medicine; Radiotherapy; Chemotherapy; Cancer; Traditional; User-characteristics; Toxicity
7.  The use of complementary and alternative medicine among people living with diabetes in Sydney 
Background
Complementary and alternative medicine (CAM) is common in patients with chronic disease such as diabetes mellitus. The primary objective of the study was to determine the overall prevalence and type of CAM use in individuals with diabetes mellitus (DM) in Western Sydney and to compare the prevalence and factors associated with CAM use with the literature.
Methods
A multicenter cross-sectional study was undertaken using a self-completed questionnaire distributed to patients with DM attending a public hospital and specialist endocrinology clinics in the region. The type of DM and pattern of CAM utilisation were analyzed.
Results
Sixty nine people responded to the questionnaire: age range of 18-75 years during a twelve week collection period. Overall, 32 respondents with diabetes were using some form of CAM, resulting in a utilisation rate of 46.3%. Twenty of the 32 CAM users used CAM specifically to treat their diabetes accounting for 28.9% of the respondent sample population. Multivitamins (40%), cinnamon, Co-enzyme q10 and prayer were the most frequently used CAM modalities. There was no significant difference between males and females, age range, income or diabetes complications between CAM and non-CAM users. (p values each > 0.05) The factor most significantly associated with CAM usage was being born overseas (p = 0.044).
Conclusions
Almost half the respondents (46.3%) used CAM: 28% used CAM specifically to treat their diabetes. Individuals born overseas were significantly more likely to use CAM than those born in Australia. Other factors such as age, gender, wealth and duration of living with diabetes were not associated with higher rate of CAM usage.
doi:10.1186/1472-6882-12-2
PMCID: PMC3295731  PMID: 22240113
8.  To Tell or Not to Tell: Shared Decision Making, CAM Use and Disclosure Among Underserved Patients with Rheumatic Diseases 
The purpose of this analysis was to assess the impact of perceived shared decision-making (SDM) on complementary and alternative medicine (CAM) use and disclosure in a sample of urban, underserved minority patients (n = 109) with rheumatic diseases. Nearly three quarters of the patients (71.6%) reported CAM use. Of these, 59% disclosed CAM use to their provider. Logistic regression models were created. In model 1 SDM significantly predicted CAM use; however, the overall model fit was not significant. In model 2, gender, ethnicity, and SDM predicted CAM disclosure with 73.2% correctly classified. Females were more likely and Hispanics were less likely to disclose CAM use. Those with higher SDM scores were more likely to disclose CAM use. SDM played a role in whether patients used CAM and disclosed CAM use to their providers. Improving SDM strategies may be especially important among patients who are least likely to disclose CAM use.
doi:10.4137/IMI.S10333
PMCID: PMC3468342  PMID: 23071389
shared decision-making; rheumatic disease; arthritis; complementary and alternative medicine; patient-provider communication
9.  Complementary and Alternative Medicine Use Was Associated with Higher Perceived Physical and Mental Functioning in Early Systemic Sclerosis 
Explore (New York, N.Y.)  2008;4(4):259-263.
Objective
This study assessed the use of complementary and alternative medicine (CAM) therapies in patients with early systemic sclerosis (scleroderma, SSc).
Methods
At the annual visit, SSc patients enrolled in the Genetics versus Environment in Scleroderma Outcomes Study (GENISOS) were queried about their use of CAM therapies and intended symptom target, including herbal or nutriceutical therapy, acupuncture, transcutaneous electrical neural stimulation (TENS) and mind-body therapy (relaxation, meditative, imagery). The CAM user SSc patients were compared to matched non-CAM users over two years for database results of demographic, clinical and health-related quality of life SF-36 questionnaires by analysis of covariance.
Results
25% of the university GENISOS group were CAM users: age: 54 years; female: 89%; diffuse cutaneous involvement: 47%; total skin score: 13.5; Medsger severity index: 5.8. Over 70% used ≥1 CAM therapies for over 1 year, independent of health insurance. Symptoms targeted included arthritis/arthralgia, pain, GI dysmotility and fatigue. CAM users had significantly higher mean mental component summary (MCS) scores on SF-36 at Baseline and Year 2, (49 and 49.9), compared to non-CAM users (42 and 40.2, respectively, p<0.01). At Year 2, the CAM user group had significantly higher scores of SF-36 domains physical component score, role-physical, bodily pain and vitality, whereas scores declined in the non-CAM user group.
Conclusion
In SSc, 70% of those in the CAM user group reported a long-term commitment to CAM therapies. Higher perceived mental functioning in CAM users might reflect more self-motivation to manage symptoms and subsequently, promote practices that result in higher perceived physical functioning.
doi:10.1016/j.explore.2008.04.004
PMCID: PMC2875784  PMID: 18602619
CAM; SF-36; Integrative Medicine; Pain; Arthritis; GI Hypomotility; Scleroderma; GENISOS
10.  The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems 
Medical care  2012;50(12):1029-1036.
Background
Health care costs associated with use of complementary and alternative medicine (CAM) by patients with spine problems have not been studied in a national sample.
Objectives
To estimate the total and spine-specific medical expenditures among CAM and non-CAM users with spine problems.
Research Design
Analysis of the 2002–2008 Medical Expenditure Panel Survey.
Subjects
Adults (> 17 years) with self-reported neck and back problems who did or did not use CAM services.
Measures
Survey-weighted generalized linear regression and propensity matching to examine expenditure differences between CAM users and non-CAM users while controlling for patient, socioeconomic and health characteristics.
Results
A total of 12,036 respondents with spine problems were included, including 4,306 (35.8%) CAM users (40.8% in weighted sample). CAM users had significantly better self-reported health, education, and comorbidity compared to non-CAM users. Adjusted annual medical costs among CAM users was $424 lower (95%CI $240, $609; p <0.001) for spine-related costs, and $796 lower (95%CI $121, $1470; p = 0.021) for total health care cost than among non-CAM users. Average expenditure for CAM users, based on propensity matching, was $526 lower for spine-specific costs (p<0.001) and $298 lower for total health costs (p=0.403). Expenditure differences were primarily due to lower inpatient expenditures among CAM users.
Conclusions
CAM users did not add to the overall medical spending in a nationally representative sample with neck and back problems. Since the causal associations remain unclear in these cross-sectional data, future research exploring these cost differences might benefit from research designs that minimize confounding.
doi:10.1097/MLR.0b013e318269e0b2
PMCID: PMC3494804  PMID: 23132198
Back and neck pain; complementary and alternative medicine; expenditures
11.  Use of Complementary and Alternative Medicine among Patients with End-Stage Renal Disease 
Among patients with end-stage renal disease (ESRD), few studies have examined the use of complementary and alternative medicine (CAM) and patients' interest in learning mind-body interventions to address health issues. We surveyed 89 adult patients (response rate 84%) at an outpatient hemodialysis center in Brookline, MA, USA regarding the utilization of CAM, including mind-body practices, and willingness to learn mind-body practices. Of respondents, 47% were female, 63% were black, and mean age was 62 years. 61% reported using CAM for health in their lifetime, and 36% reported using CAM within a month of the survey. The most frequent CAM modalities reported in ones' lifetime and in the last month were mind-body practices (42% and 27%, resp.). Overall lifetime CAM use did not differ significantly by sex, race, dialysis vintage, diagnosis of ESRD, employment status, or education level. Subjects reported that mind-body interactions were very important to health with a median score of 9 on a 10-point Likert scale (ranging from 0 for not important to 10 for extremely important). Most patients (74%) reported interest in learning mind-body practices during maintenance hemodialysis. In summary, CAM use, particularly mind-body practice, is frequent among patients with ESRD providing opportunities for future clinical research.
doi:10.1155/2013/654109
PMCID: PMC3655568  PMID: 23710227
12.  Complementary and alternative medicine use in children and adolescents with type 1 diabetes 
Paediatrics & Child Health  2011;16(8):468-472.
BACKGROUND:
The use of complementary and alternative medicine (CAM) in paediatric patients varies between 11% and 68%. There are limited reports of its use in children with type 1 diabetes mellitus (T1DM).
OBJECTIVE:
To describe the use of CAM in children with T1DM, and the perceptions of both users and nonusers regarding the effect of CAM on diabetes management.
DESIGN/METHODS:
A cross-sectional, anonymous questionnaire survey was mailed to a randomly selected subgroup of patients with T1DM. Each patient’s main caregiver was asked to complete the questionnaire.
RESULTS:
Of 403 questionnaires mailed, 195 (48%) were completed. The mean (± SD) age of the children was 12.2±4.0 years (56% boys). Use of CAM was reported in 110 children (56%) (vitamins/minerals [n=99], herbal medicine [n=22], dietary supplement [n=13]). When excluding the use of vitamins/minerals, the CAM number dropped to 47 children (24%). Only the current age of the child was significantly different between users and nonusers of CAM. In users, reasons cited for using CAM were to minimize symptoms, improve control, prevent complications and add benefits to insulin. Only 30% of CAM users stated that CAM improved diabetes control. Nonusers cited satisfaction with current diabetes treatment and lack of knowledge as reasons for not using CAM.
CONCLUSIONS:
CAM use in children with T1DM was frequent, and appeared to be an attempt to improve control or prevent diabetes complications. However, improved control was not reported as a benefit. Diabetes care teams should assess the use of CAM in children with T1DM, and monitor for any potential positive or negative effects.
PMCID: PMC3202385  PMID: 23024584
CAM; Children; Complementary and alternative medicine; Type 1 diabetes
13.  Complementary and Alternative Medicine Use in African Americans With Rheumatoid Arthritis 
Arthritis care & research  2014;66(2):180-189.
Objective.
Racial/ethnic differences with regard to complementary and alternative medicine (CAM) use have been reported in the US. However, specific details of CAM use by African Americans with rheumatoid arthritis (RA) are lacking.
Methods.
Data were collected from African Americans with RA enrolled in a multicenter registry regarding the use of CAM, including food supplements, topical applications, activities, and alternative care providers. Factors associated with CAM use by sex and disease duration were assessed using t-test, Wilcoxon’s rank sum test, chi-square test, and logistic regression analyses.
Results.
Of the 855 participants, 85% were women and mean age at enrollment was 54 years. Overall, ever using any of the CAM treatments, activities, and providers was 95%, 98%, and 51%, respectively (median of 3 for number of treatments, median of 5 for activities, and median of 1 for providers). Those with longer disease duration (>2 years) were significantly more likely (odds ratio >2.0, P < 0.05) to use raisins soaked in vodka/gin, to take fish oils, or to drink alcoholic beverages for RA treatment than those with early disease. As compared to men, women were significantly (P < 0.05) more likely to pray/attend church, write in a journal, and use biofeedback, but were less likely to smoke tobacco or topically apply household oils for treatment of RA.
Conclusion.
CAM use was highly prevalent in this cohort, even in individuals with early disease. Health care providers need to be aware of CAM use as some treatments may potentially have interactions with conventional medicines. This could be important within this cohort of African Americans, where racial disparities are known to affect access to conventional care.
doi:10.1002/acr.22148
PMCID: PMC3977347  PMID: 23983105
14.  Patients in Northwestern Turkey Prefer Herbs as Complementary Medicine after Breast Cancer Diagnosis 
Breast Care  2008;3(4):269-273.
Summary
Background
A cross-sectional survey was conducted in order to define the prevalence, pattern, and predictors of complementary and alternative medicine (CAM) use in breast cancer patients in northwestern Turkey.
Patients and Methods
All patients admitted to the breast center between January 2005 and January 2006 were consecutively included in the study. Demographics and clinical data of study patients were noted. A 15-item questionnaire was used to document the attitude of breast cancer patients towards CAM modalities. Primary outcomes were prevalence, pattern, and predictors of CAM. Secondary outcomes were the reasons for CAM use, the number and type of adverse events related to CAM use, and the satisfaction level of CAM users.
Results
Nearly one third of breast cancer patients use at least one type of CAM in addition to conventional therapy. Most chose herbal medicines which they think support their general health status. Nettle (Urtica diocia/U. urens) was the most common herbal medicine that patients consume. Previous experience with CAM was the most significant factor for CAM use after breast cancer diagnosis. Being young and married as well as receiving radiotherapy were among other independent factors for using any CAM modality.
doi:10.1159/000144045
PMCID: PMC2974983  PMID: 21113280
Breast cancer; Complementary medicine; Supportive care; Therapy
15.  Complementary and alternative medicine use by patients visiting a free health clinic: A single-site, pilot study 
Background:
The rate of use of complementary and alternative medicine (CAM) has been documented to fluctuate widely, can greatly impact medical outcomes, and can influence patients' adherence to conventional medicines. Health care providers should assess the prevalence of CAM use (primarily herbal medicine) in individual settings to most accurately provide appropriate patient care.
Objectives:
The aim of this study was to determine the following: (1) differences in demographic characteristics between users and nonusers of CAM; (2) which CAM patients are using; (3) patients' sources of information concerning CAM; and (4) whether patients recall being asked about CAM use by their health care providers.
Methods:
In this single-center, pilot study, a self-administered survey concerning CAM use was made available to persons seeking care at an inner-city free health clinic (Kansas City Free Health Clinic, Kansas City, Missouri). Completed surveys were scanned into a database, and descriptive analyses were performed.
Results:
Three hundred eleven patients completed ≥1 question on the survey. Of those who reported race (n = 278), 168 (60.4%) were Caucasian/white, 73 (26.3%) were African American/black, and 24 (8.6%) were Hispanic/Latino. Of those who reported educational level (n = 287), 101 (35.2%) had some high school or were high school graduates or had a general equivalency development diploma, 102 (35.5%) had completed some college or vocational training, and 84 (29.3%) had completed college. Of those who reported personal annual income (n = 191), 107 (56.0%) reported up to US $15,000, and 54 (28.3%) reported >$15,000 to $30,000. A high rate of CAM use (past or present) was found among survey respondents (116/285 [40.7%]). No correlation was found between CAM use and any of the demographic characteristics studied. Of 98 patients reporting whether their CAM use was past or current, 64 (65.3%) were using CAM at the time of the survey. Friends and physicians were reported to be most supportive of CAM use (21/41 [51.2%] and 33/86 [38.4%] patients, respectively). The most common CAM products reported as being currently used were garlic and chamomile (both, 5 patients [7.1%]), and echinacea and ginseng (both, 3 patients [4.7%]).
Conclusion:
This survey of patients using an inner-city free health clinic showed a high rate of CAM use, which could significantly impact patient outcomes.
doi:10.1016/j.curtheres.2005.01.005
PMCID: PMC3964552
alternative; complementary; medically indigent; inner city; educational level
16.  Complementary and Alternative Medicine: A Survey of Its Use in Pediatric Oncology 
Background. The use of complementary and alternative medicine (CAM) is high among children and youths with chronic illnesses, including cancer. The objective of this study was to assess prevalence and patterns of CAM use among pediatric oncology outpatients in two academic clinics in Canada. Procedure. A survey was developed to ask patients (or their parents/guardians) presenting to oncology clinics at the Stollery Children's Hospital in Edmonton and the Children's Hospital of Eastern Ontario (CHEO) in Ottawa about current or previous use of CAM products and practices. Results. Of the 137 families approached, 129 completed the survey. Overall CAM use was 60.5% and was not significantly different between the two hospitals. The most commonly reported reason for not using CAM was lack of knowledge about it. The most common CAM products ever used were multivitamins (86.5%), vitamin C (43.2%), cold remedies (28.4%), teething remedies (27.5%), and calcium (23.0%). The most common CAM practices ever used were faith healing (51.0%), massage (46.8%), chiropractic (27.7%), and relaxation (25.5%). Many patients (40.8%) used CAM products at the same time as prescription drugs. Conclusion. CAM use was high among patients at two academic pediatric oncology clinics. Although most respondents felt that their CAM use was helpful, many were not discussing it with their physicians.
doi:10.1155/2013/527163
PMCID: PMC3836302  PMID: 24307910
17.  Disclosure of Complementary and Alternative Medicine to Conventional Medical Providers: Variation by Race/Ethnicity and Type of CAM 
Background
Complementary and alternative medicine (CAM) is often used alongside conventional medical care, yet fewer than half of patients disclose CAM use to medical doctors. CAM disclosure is particularly low among racial/ethnic minorities, but reasons for differences, such as type of CAM used or quality of conventional healthcare, have not been explored.
Objective
We tested the hypotheses that disclosure of CAM use to medical doctors is higher for provider-based CAM and among non-Hispanic whites, and that access to and quality of conventional medical care account for racial/ethnic differences in CAM disclosure.
Methods
Bivariate and multiple variable analyses of the 2002 National Health Interview Survey and 2001 Health Care Quality Survey were performed.
Results
Disclosure of CAM use to medical providers was higher for provider-based than self-care CAM. Disclosure of any CAM was associated with access to and quality of conventional care and higher among non-Latino whites relative to minorities. Having a regular doctor and quality patient–provider relationship mitigated racial/ethnic differences in CAM disclosure.
Conclusion
Insufficient disclosure of CAM use to conventional providers, particularly for self-care practices and among minority populations, represents a serious challenge in medical encounter communications. Efforts to improve disclosure of CAM use should be aimed at improving consistency of care and patient–physician communication across racial/ethnic groups.
PMCID: PMC2709648  PMID: 19024232
complementary and alternative medicine; race/ethnicity; communication; access; quality of care
18.  Classification of CAM Use and its Correlates in Early Stage Breast Cancer Patients 
Integrative cancer therapies  2011;10(2):138-147.
Hypothesis
Self-reported use of complementary and alternative medicine (CAM) has been shown to increase following a cancer diagnosis, and breast cancer survivors are the heaviest users among cancer survivors. The aim of this study was to determine whether the prevalence estimate of CAM use varied according to classification of CAM. We used a comprehensive system to classify CAM users and test differences in demographic, lifestyle, quality of life, and cancer characteristics among them.
Study Design and Methods
Participants were 2562 breast cancer survivors participating in the Women's Healthy Eating and Living (WHEL) Study, aged 28-74 years. A structured telephone interview assessed CAM use, questioning about specific CAM practices, and whether use was related to cancer. We examined CAM use in relation to demographics, health behaviors, and quality of life.
Results
Approximately 80% of the women used CAM for general purposes but only 50% reported CAM use for cancer purposes. Visual imagery, spiritual healing, and meditation were the most frequently used practices for cancer purposes. CAM use, defined as consulting a CAM practitioner and regular use, was significantly related to younger age, higher education, increased fruit & vegetable intake, and lower body mass index (p < .05). CAM users who had seen a practitioner were also more likely to report poor physical and mental health than non-CAM users (p < .05). CAM use was not associated with changes in physical and mental health between study baseline and 1-year follow-up.
Conclusion
This study addressed important differences in the classification of CAM use among breast cancer survivors. Future studies need to further test the potential benefits and risks associated with CAM use.
doi:10.1177/1534735410392578
PMCID: PMC3126886  PMID: 21382963
19.  Disclosure of Complementary and Alternative Medicine Use to Health Care Providers among HIV-Infected Women 
AIDS patient care and STDs  2009;23(11):965-971.
To determine prevalence and predictors of complementary and alternative medicine (CAM) use disclosure to health care providers and whether CAM use disclosure is associated with highly active antiretroviral therapy (HAART) adherence among HIV-infected women, we analyzed longitudinal data collected between October 1994 and March 2002 from HIV-infected CAM-using women enrolled in the Women’s Interagency HIV Study. Repeated measures Poisson regression models were constructed to evaluate associations of selected predictors with CAM use disclosure and association between CAM use disclosure and HAART adherence. A total of 1377 HIV-infected women reported CAM use during study follow-up and contributed a total of 4689 CAM-using person visits. The overall prevalence of CAM use disclosure to health care providers was 36% across study visits. Women over 45 years old, with a college education, or with health insurance coverage were more likely to disclose their CAM use to health care providers, whereas women identified as non-Hispanic Black or other ethnicities were less likely to communicate their CAM usage. More health care provider visits, more CAM domains used, and higher health care satisfaction scores had significant relationships with increased levels of CAM use disclosure. Restricting analysis to use of herbal or nonherbal medications only, similar results were obtained. Compared to other CAM domains, mind–body practice had the lowest prevalence of CAM use disclosure. Additionally, CAM use disclosure was significantly associated with higher HAART adherence. From this study, we showed that a high percentage of HIV-infected women did not discuss their CAM use with health care providers. Interventions targeted towards both physicians and patients may enhance communication of CAM use, avoid potential adverse events and drug interactions, and enhance HAART adherence.
doi:10.1089/apc.2009.0134
PMCID: PMC2801553  PMID: 19821723
20.  Disclosure of Complementary and Alternative Medicine Use to Health Care Providers among HIV-Infected Women 
AIDS Patient Care and STDs  2009;23(11):965-971.
Abstract
To determine prevalence and predictors of complementary and alternative medicine (CAM) use disclosure to health care providers and whether CAM use disclosure is associated with highly active antiretroviral therapy (HAART) adherence among HIV-infected women, we analyzed longitudinal data collected between October 1994 and March 2002 from HIV-infected CAM-using women enrolled in the Women's Interagency HIV Study. Repeated measures Poisson regression models were constructed to evaluate associations of selected predictors with CAM use disclosure and association between CAM use disclosure and HAART adherence. A total of 1377 HIV-infected women reported CAM use during study follow-up and contributed a total of 4689 CAM-using person visits. The overall prevalence of CAM use disclosure to health care providers was 36% across study visits. Women over 45 years old, with a college education, or with health insurance coverage were more likely to disclose their CAM use to health care providers, whereas women identified as non-Hispanic Black or other ethnicities were less likely to communicate their CAM usage. More health care provider visits, more CAM domains used, and higher health care satisfaction scores had significant relationships with increased levels of CAM use disclosure. Restricting analysis to use of herbal or nonherbal medications only, similar results were obtained. Compared to other CAM domains, mind–body practice had the lowest prevalence of CAM use disclosure. Additionally, CAM use disclosure was significantly associated with higher HAART adherence. From this study, we showed that a high percentage of HIV-infected women did not discuss their CAM use with health care providers. Interventions targeted towards both physicians and patients may enhance communication of CAM use, avoid potential adverse events and drug interactions, and enhance HAART adherence.
doi:10.1089/apc.2009.0134
PMCID: PMC2801553  PMID: 19821723
21.  Complementary and alternative asthma treatments and their association with asthma control: a population-based study 
BMJ Open  2013;3(9):e003360.
Objectives
Many patients with asthma spend time and resources consuming complementary and alternative medicines (CAMs). This study explores whether CAM utilisation is associated with asthma control and the intake of asthma controller medications.
Design
Population-based, prospective cross-sectional study.
Setting
General population residing in two census areas in the province of British Columbia, Canada. Recruitment was based on random-digit dialling of both landlines and cell phones.
Participants
486 patients with self-reported physician diagnosis of asthma (mean age 52 years; 67.3% woman).
Primary and secondary outcome measures
We assessed CAM use over the previous 12 months, level of asthma control as defined by the Global Initiative for Asthma and the self-reported intake of controller medications. Multivariate logistic regression was performed to study the relationship between any usage of CAMs (outcome), asthma control and controller medication usage, adjusted for potential confounders.
Results
A total of 179 (36.8%) of the sample reported CAM usage in the past 12 months. Breathing exercises (17.7%), herbal medicines (10.1%) and vitamins (9.7%) were the most popular CAMs reported. After adjustment, female sex (OR 1.66; 95% CI 1.09 to 2.52) and uncontrolled asthma (vs controlled asthma, OR 2.25, 95% CI 1.30 to 3.89) were associated with a higher likelihood of using any CAMs in the past 12 months. Controller medication use was not associated with CAM usage in general and in the subgroups defined by asthma control.
Conclusions
Clinicians and policy makers need to be aware of the high prevalence of CAM use in patients with asthma and its association with lack of asthma control.
doi:10.1136/bmjopen-2013-003360
PMCID: PMC3773646  PMID: 24005131
Complementary Medicine
22.  Necessary alternatives: patients’ views of asthma treatment 
This article is based on semistructured interviews and focus groups conducted with 27 asthma patients in The Netherlands who chose complementary and alternative medicine (CAM) for treatment of their condition. All subjects were contacted through an online forum for asthma patients hosted by the Dutch Asthma Foundation. Nineteen subjects (12 women and seven men) between the ages of 29 and 65 years participated in the interviews, held between June 2009 and January 2010. All of the participating subjects had experience with conventional medications, including anti-inflammatory corticosteroids and bronchodilators. For the focus group meeting, held in February 2010, the sample included seven subjects (four women and three men) between the ages of 31 and 46 years, none of whom had ever used conventional medication and all of whom were using CAM. All subjects in the sample had been diagnosed with asthma by their physician or lung specialist. The study examined the causes of patient noncompliance with the prescribed medical regime. It is argued that evidence-based rationality on the part of subjects is an overlooked dimension of their experience of asthma. This study demonstrates the role that the patients’ social network, including medical practitioners, friends, and family, and other asthmatics, plays in the process of decision-making and choices about treating asthma. It also demonstrates the role of patients’ information-searching strategies. The author concludes that patient noncompliance with commonly prescribed medication and selection of alternative medical treatment is less a matter of denial of their diagnosis or the severity of their illness, but more a matter of choice informed by evidence-based rationality.
PMCID: PMC2898120  PMID: 20622919
asthma; complementary alternative and medicine (CAM); evidence-based medicine (EBM); patient non-compliance; decision-making; indentity
23.  Prevalence and Correlates of Postdiagnosis Initiation of Complementary and Alternative Medicine Among Patients at a Comprehensive Cancer Center 
Journal of Oncology Practice  2012;9(1):34-41.
Patients with cancer increasingly use complementary and alternative medicine (CAM) in conjunction with conventional oncology treatments. This study looks at the prevalence and correlates of individual CAM modalities initiated after cancer diagnosis.
Purpose:
Patients with cancer increasingly use complementary and alternative medicine (CAM) in conjunction with conventional oncology treatments. Previous studies have not investigated postdiagnosis initiation of CAM therapies or independent correlates of use of individual CAM modalities. The purpose of this study was to determine the prevalence and correlates of individual CAM modalities initiated after cancer diagnosis.
Methods:
A cross-sectional survey was conducted of a random sample of adults with a cancer diagnosis (N = 1,228) seeking care at a National Cancer Institute–designated comprehensive cancer center within a 12-month period.
Results:
The majority of patients were female (64.7%), white (86.9%), and married (72.8%).Three-quarters (75.2%) used at least one CAM modality, and 57.6% of those using CAM initiated use after cancer diagnosis. For all CAM therapies combined, women were 1.7 times more likely than men to initiate any CAM therapy after cancer diagnosis. However, when CAM modalities were differentiated by type, men and women were equally likely to initiate all therapies except for psychotherapy and mind-body approaches. Postdiagnosis initiation of every CAM modality, except mind-body therapies, differed by cancer type.
Conclusion:
A significant proportion of patients initiated CAM use after diagnosis. However, specific type of CAM initiated varied by demographics and cancer type, suggesting there is not a “typology” of CAM user. Optimal comprehensive cancer treatment, palliation, and survivorship care will require patient and provider education regarding CAM use by modality type; improved provider-patient communication regarding potential benefits, limitations, and risks; and institutional policies to support integrated conventional and CAM treatment.
doi:10.1200/JOP.2012.000634
PMCID: PMC3545661  PMID: 23633969
24.  Use of Complementary and Alternative Medicine in Inner-City Persons with or at Risk for HIV Infection 
AIDS Patient Care and STDs  2008;22(10):811-816.
Abstract
Previous studies have shown that use of complementary and alternative medicine (CAM) is prevalent among HIV-infected persons, but have focused primarily on men who have sex with men. To determine factors associated with CAM use in an inner city population, individuals (n = 93) recruited from two established cohort studies were interviewed between October and November 2004. The interview assessed the use of dietary supplements and other CAM therapies, reasons for CAM use, and use of prescription medications. Study participants were 52% male and 47% HIV infected. Median age was 50 years, and 60% reported illicit drug use ever. CAM use during the prior 6 months was reported by 94%, with 48% reporting daily use of a dietary supplement. Vitamin C, vitamin E, and soy were used more often by HIV-infected than uninfected persons (p < 0.05). Prevention of illness was the most common reason for dietary supplement use (27%). HIV-infected persons were more likely than uninfected persons (95% versus 67%) to report use of both dietary supplements and prescription medications within the past 6 months (p < 0.001). In multivariate analysis, HIV infection (odds ratio [OR] 3.1, CI 1.3, 7.7) was the only factor associated with daily dietary supplement use whereas gender, race/ethnicity, working in the last year, homelessness, and financial comfort were not associated. CAM use among persons with or at risk for HIV infection due to drug use or high-risk heterosexual behaviors is common, and is used almost exclusively as an adjunct and not an alternative to conventional health care.
doi:10.1089/apc.2007.0159
PMCID: PMC2587224  PMID: 18847387
25.  Complementary and Alternative Medicine use in women during pregnancy: do their healthcare providers know? 
Background
The National Institutes of Health reported in 2007 that approximately 38% of United States adults have used at least one type of Complementary and Alternative Medicine (CAM). There are no studies available that assess general CAM use in US pregnant women.
The objectives of our study were to determine the prevalence and type of CAM use during pregnancy at one medical center; understand who is using CAM and why they are using it; and assess the state of patients’ CAM use disclosure to their obstetrical providers.
Methods
A cross-sectional survey study of post-partum women was done to assess self-reported CAM use during pregnancy. Results of this survey were compared to results from a previous survey performed by this research team in 2006. Data were analyzed using binary logistic regression.
Results
In 2013, 153 women completed the survey, yielding a response rate of 74.3%. Seventy-two percent and 68.5% of participants reported CAM use during their pregnancies in 2006 and 2013 respectively. The percentage of participants who reported discussing CAM use with their obstetrical providers was less than 1% in 2006 and 50% in 2013. Increased use of different CAM therapies was associated with increased maternal age, primagravida, being US-born, and having a college education (p ≤ 0.05). However, these factors were poor predictors of CAM use.
Conclusions
Given the frequency of CAM use and the difficulty in predicting who is using it, obstetrical providers should consider being informed about CAM and incorporating discussions about its use into routine patient assessments.
doi:10.1186/1472-6882-14-85
PMCID: PMC3945795  PMID: 24592860
Complementary and Alternative Medicine; Pregnancy; Maternal-fetal health; Patient-physician communication; Self-care; Prevalence; Cross-sectional study

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