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1.  Iyengar Yoga and the Use of Props for Pediatric Chronic Pain: A Case Study 
Iyengar yoga uses postures and props to support the body so that practitioners can engage in poses that would otherwise be more difficult. This type of yoga may be useful in treating children and adolescents who have chronic pain and disability. In this case study, the authors discuss a 14-y-old girl who had two surgeries for gastro-esophageal reflux disease (GERD) and who had continued chest and abdominal pain, as well as vomiting, difficulty eating, weight loss, and anxiety. Having significantly impaired functioning, she was unable to attend school, sleep, socialize, or eat, and she had become wheelchair-bound. Despite evaluations and treatments by specialists over an extended period of time, her symptoms had not improved. This case history describes how the authors used a 4-mo treatment of Iyengar yoga to help the adolescent resume activities and re-engage with her environment. The authors intend this report to stimulate scientific study of this form of treatment for children and adolescents with chronic pain.
PMCID: PMC3836371  PMID: 23981408
2.  Racial Disparities in the Use of Chiropractic Care Under Medicare 
Context
Medicare covers chiropractic care, but the health-care community knows little about the demographic characteristics of older adults who use chiropractic services under the Medicare program. Researchers do not know the demographic composition of chiropractic users under Medicare, how the demographics of chiropractic use and rates of use have changed over time, and how users' characteristics vary geographically across the United States. An understanding of the demographics of chiropractic users can help chiropractic organizations, policy makers, and other stakeholders plan for an equitable allocation of resources to meet the chiropractic health-care needs of all of Medicare's beneficiaries.
Objective
The study intended to evaluate Medicare administrative data to determine (1) longitudinal trends in the demographic composition of the population that used chiropractic services, (2) longitudinal trends in rates of chiropractic use by demographic group, and (3) geographic variations in chiropractic use among minorities.
Design
The research team used a serial cross-sectional design to analyze administrative data for beneficiaries of Medicare during the years 2002 to 2008, using a 20% random sample that provided those beneficiaries' racial and geographical characteristics. The team restricted the study's actual sample to adults aged 65 to 99 and defined chiropractic users as beneficiaries who had at least one paid claim for chiropractic care on a date of service in an analyzed calendar year.
Outcome Measure(s)
For each state in the United States and the District of Columbia for each of the 7 years studied, the team determined the number of chiropractic users in total and the number of users in selected demographic categories and calculated percentage estimates and averages for each category. The team analyzed 2008 data for rates of use within racial groups and for geographic variations in those rates and quantified variations in rates by state using the coeffcient of variation (CV). The team mapped race-specific rates for selected minorities, categorized by quintiles, to illustrate geographic variations by state.
Results
Analysis by beneficiary's race showed that the proportion of chiropractic users who were white hovered at 96% to 97% throughout the time period studied, while 1% to 2% were black. Each of the other racial categories comprised 1% or less of users, and the percentages showed little change over time. Rates among racial minorities showed greater geographic variation than did rates for whites. The greatest geographic variations in use by specific racial minorities occurred among Hispanics, Asians, and Native Americans.
Conclusion
The research team's results showed little longitudinal variation in the demographics of chiropractic use under Medicare but a striking difference in rates of use between whites and minorities, and substantial geographic variations in user rates among racial minorities. The research team's findings suggest the possibility that barriers may exist for minorities' access to chiropractic care. As minority populations in the US continue to grow, the health-care community can expect that any impact on population health that these barriers cause will grow as well.
PMCID: PMC3590798  PMID: 23251940
3.  Chamomile (Matricaria recutita) May Have Antidepressant Activity in Anxious Depressed Humans - An Exploratory Study 
Objective
As part of a randomized, double-blind, placebo-controlled study, we examined the antidepressant action of oral chamomile (Matricaria recutita) extract in subjects with co-morbid anxiety and depression symptoms. We hypothesized that chamomile may demonstrate a clinically meaningful antidepressant activity versus placebo.
Methods
57 subjects received either chamomile extract or placebo therapy. Nineteen subjects had anxiety with co-morbid depression, 16 had anxiety with past history of depression, and 22 had anxiety with no current or past depression. Generalized estimating equations analysis was used to identify clinically meaningful changes over time in Hamilton Depression Rating (HAM-D) rating outcome measures among treatment groups.
Results
We observed a significantly greater reduction in mean total HAM-D scores (p<0.05) and HAM-D core depression item score (p<0.05) for chamomile versus placebo in all subjects, and a non-significant trend for a greater reduction in HAM-D core depression score for chamomile versus placebo in subjects with anxiety with current co-morbid depression (p=0.062).
Conclusion
Chamomile may have clinically meaningful antidepressant activity that occurs in addition to its previously observed anxiolytic activity.
PMCID: PMC3600408  PMID: 22894890
Antidepressant; Chamomile; Depression; Complementary & Alternative Medicine; Matricaria recutita
4.  USE OF COMPLEMENTARY AND ALTERNATIVE THERAPIES BY RURAL AFRICAN AMERICANS WITH TYPE 2 DIABETES 
The prevalence of type 2 diabetes among non-Hispanic African American adults aged 20 years and older is 11.4%, compared to 8.4% non-Hispanic whites. Given the high rate of diabetes in this population, it is important to determine whether African Americans use complementary and alternative medicine (CAM), and if so, what kind. Such information is important to healthcare professionals who prescribe therapies and make self-care recommendations to those with diabetes. The use of CAM by African Americans with diabetes has not been well studied, however, particularly among those living in rural areas. This descriptive study was conducted in 2 rural communities in Central Virginia to explore the use of CAM therapies and the role of religion and spirituality in dealing with diabetes among adult African Americans with type 2 diabetes. Sixty-eight participants attended 1 of 8 focus group sessions in various community settings and described their use of alternative therapies. According to these sessions, the most common alternative therapies used are prayer, diet-based therapies, and natural products. The participants’ descriptions enhance our understanding of CAM use among rural African Americans with diabetes.
PMCID: PMC3665110  PMID: 17017753
5.  Policosanol for Managing Human Immunodeficiency Virus–related Dyslipidemia in a Medically Underserved Population: A Randomized, Controlled Clinical Trial 
Background
Human immunodeficiency virus (HIV) infection is associated with dyslipidemia and increased risk for cardiovascular events; however, the use of statins in HIV-infected people is complicated by pharmacokinetic interactions and overlapping toxicities with antiretroviral medications. Policosanol is a dietary supplement derived from sugar cane that is widely used as a statin alternative in Latin America.
Primary Study Objective
To collect feasibility data on sugar cane–derived policosanol to normalize dyslipidemic profiles in a sample of medically underserved HIV-infected people.
Methods/design
Randomized, controlled, double-blind clinical trial.
Setting
Two infectious disease outpatient clinics located in a Health Resources Service Administration–designated medically underserved neighborhood in Chicago, Illinois.
Participants
Fifty-four clinically stable HIV-infected people (91% black) with at least one lipid abnormality that warranted dietary modifications and/or drug therapy.
Intervention
Participants received either 20 mg/day of policosanol or placebo for 12 weeks, followed by a 4-week washout and crossover to the other arm.
Primary Outcome Measures
Efficacy measures included the standard lipid panel (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides) and nuclear magnetic resonance (NMR)–derived lipoprotein particle profiles. Safety measures included CD4+ T lymphocyte counts, plasma HIV ribonucleic acid levels, serum creatinine, and liver function tests.
Results
Policosanol supplementation was not associated with normalization of any dyslipidemic parameters as measured by the standard lipid panel or NMR spectroscopy–measured lipoprotein size or concentration. The supplement was well tolerated and was not associated with any changes in parameters of HIV disease progression.
Conclusions
Our findings corroborate recent studies conducted outside Cuba that have failed to find any lipid modulatory effects for policosanol.
PMCID: PMC3654198  PMID: 21717822
6.  [No title available] 
PMCID: PMC3644485  PMID: 22314632
7.  Uncovering the expectancy effect: the validation of Acupuncture Expectancy Scale 
Purpose
Research suggests that expectancy may modulate the response to medical interventions, including acupuncture. However, the paucity of validated tools to measure expectancy limits rigorous evaluation. We sought to validate a previously developed Acupuncture Expectancy Scale (AES) as an instrument to measure patients’ expected responses to acupuncture.
Methods
Participants were patients with stage I to III cancers seen in outpatient medical and radiation oncology clinics. They were drawn from three study cohorts that included 404 participants. We examined the reliability, validity and responsiveness of AES.
Results
The scores of AES had internal consistency (Cronbach’s α coefficient) of 0.95 and test-retest reliability of 0.62 over four weeks without acupuncture treatment. Those who had previously used acupuncture had higher AES compared to those who were acupuncture naïve (12.4 vs. 9.5, p=0.002). AES was higher in those who reported willingness to participate in an acupuncture trial compared to those who did not want to participate in an acupuncture trial (11.5 vs. 8.1, p<0.001). Those patients who enrolled in a pilot trial of acupuncture had higher AES score than the general outpatient population (13.0 vs. 9.8, p=0.02), and expectancy increased during the course of acupuncture treatment (13.0 to 16.5, p<0.017).
Conclusion
The AES is reliable and valid, and scores appear to increase during or after prior therapy. Incorporation of AES in clinical trials and outcome studies can evaluate the role of expectancy on acupuncture outcomes.
PMCID: PMC3569526  PMID: 21280459
8.  The Concentration of Out-of-pocket Expenditures on Complementary and Alternative Medicine in the United States 
Context
The most intense spenders on health services are considerably less healthy—49% report fair or poor health status compared to 15% of the general adult population— and are elderly. Such findings have important implications for addressing national health-care spending because interventions targeting those people who are in poor health could theoretically generate dramatic cost savings. Although the popularity of complementary and alternative medicine (CAM) in the US is well recognized, little is known about the distribution of out-of-pocket expenditures on CAM services.
Objective
This study examined the distribution of out-of-pocket expenditures on CAM health services in the US.
Design
The research team used data from the 2007 National Health Interview Survey to examine the distribution in the US of out-of-pocket expenditures on CAM services and the characteristics of adult (age ≥ 18 years) CAM users (n = 2972) according to spending.
Outcome Measures
Using complex survey-design methods, the research team generated national estimates of expenditures on CAM services and used linear regression adjusted for covariates to determine whether self-reported health status predicted CAM spending.
Results
According to our estimates, in 2007, over 30 million adults reported out-of-pocket expenditures on CAM services, and of these individuals, 7.2 million were heavy CAM spenders with a mean annual expenditure of $1385. The highest quartile of CAM spenders accounted for $10 billion of the $13.9 billion spent nationally on CAM in 2007. Self-reported health status did not differ among groups with differing levels of CAM spending, β̂ = 1.00 (95% CI, 0.8–1.2).
Conclusions
Out-of-pocket spending on CAM is concentrated. Just a quarter of CAM users account for over 70% of all expenditures on CAM services, and health status does not appear to be associated with level of CAM spending.
PMCID: PMC3523202  PMID: 22894889
9.  Short-term Garlic Supplementation and Highly Active Antiretroviral Treatment Adherence, CD4+ Cell Counts, and Human Immunodeficiency Virus Viral Load 
Context
Human immunodeficiency virus (HIV)–infected individuals frequently have consumed garlic, a popular complementary supplement. Researchers rarely have studied garlic’s association with antiretroviral therapies, however, even though that association is very relevant clinically.
Objective
To examine associations of supplemental use of garlic with highly active antiretroviral treatment (HAART) adherence level and HAART effectiveness (HIV viral load and CD4+ cell counts) in HIV-infected women.
Design
The research team carried out a self-controlled, longitudinal study nested within the Women’s Interagency HIV Study (WIHS). The team used a paired study design that allowed participants to serve as their own controls. The team first identified all of the study’s visits in which the participant self-reported the use of a garlic supplement since her last visit (index visit). Then for each index visit, the team identified a matching visit (a control visit) using the following criteria: (a) the visit must be one for the same participant in which that participant reported no garlic supplementation; (b) the visit must immediately precede the index visit (less than 1 year apart); and (c) at the time of the control visit, the participant must have been using antiretroviral therapy identical to that used at the time of the index visit.
Participants
Participants were persons using garlic supplementation who already were participants in the WIHS.
Outcome Measures
The research team used a logistic regression model to examine the association between garlic supplementation and HAART adherence level. The team used a mixed linear model to examine the association of garlic supplementation with HIV viral load and CD4+ cell counts.
Results
From October 1994 to April 2009, 390 HIV-infected women in the WIHS made 1112 visits at which they reported using garlic supplements. Seventy-seven HIV-infected women using HAART met the research team’s selection criteria and contributed 99 pairs of visits for the study. Among the women who used garlic supplements, 22% were 50 years and older; 58% were black and non-Hispanic; and 23% had less than a high-school education. Neither use of garlic supplementation nor reasons for using garlic supplements were significantly associated with the HAART adherence level, HIV viral load, or CD4+ cell counts; however, “use garlic as needed,” a potential marker of a disease state, was significantly associated with higher viral load (P = .0003).
Conclusion
Short-term garlic supplementation did not impact HAART adherence level, HIV viral load, and CD4+ cell counts.
PMCID: PMC3376904  PMID: 22516847
10.  Development and classification of an operational definition of complementary and alternative medicine for the Cochrane Collaboration 
Over the past decade the Cochrane Collaboration has been an increasingly important source of information on complementary and alternative medicine (CAM) therapies. From 2007 to 2008 the Cochrane CAM Field developed a topics list that allowed us to categorize all 396 Cochrane reviews related to CAM (as of The Cochrane Library, Issue 4, 2009). This topics list is an advance in making Cochrane reviews on CAM topics accessible to the public. In this paper, we discuss challenges in developing the topics list, including developing an operational definition of CAM, deciding which reviews should be included within the CAM Field’s scope, developing the structured list of CAM Field-specific topics, and determining where in the topics list the reviews should be placed. Although aspects of our operational definition of CAM are open to revision, a standardized definition provides us with an objective, reproducible and systematic method for defining and classifying CAM therapies.
PMCID: PMC3196853  PMID: 21717826
complementary medicine; systematic reviews; randomized trials; evidence-based medicine; Cochrane Collaboration
11.  Mindfulness-Based Stress Reduction for Solid Organ Transplant Recipients: A Randomized Controlled Trial 
Context
Patients who have received solid organ transplants continue to experience a myriad of complex symptoms related to their underlying disease and to chronic immunosuppression that reduce the quality of life. Beneficial non-pharmacologic therapies to address these symptoms have not been established in the transplant population.
Objective
Assess the efficacy of Mindfulness-Based Stress Reduction (MBSR) in reducing symptoms of anxiety, depression, and poor sleep in transplant patients.
Design, Setting and Patients
Controlled trial with a 2-staged randomization. Recipients of kidney, kidney/pancreas, liver, heart or lung transplants were randomized to MBSR (n=72) or Health Education (n=66) initially or after serving on a waitlist. Mean age was 54 (range 21–75 years); 55% were men and 91% were white.
Interventions
MBSR, a mindfulness meditation training program consisting of 8 weekly 2.5 hour classes; Health Education, a peer-led active control.
Primary Outcome Measures
Anxiety (STAI), depression (CES-D), and sleep quality (PSQI) scales assessed by self-report at baseline, 8 weeks, 6 months and 1 year.
Results
Benefits of MBSR were above and beyond those afforded by the active control. MBSR reduced anxiety and sleep symptoms (Ps<0.02), with medium treatment effects (0.51 and 0.56) at 1 year compared to Health Education in intention-to-treat analyses. Within the MBSR group anxiety, depression and sleep symptoms decreased and quality of life measures improved by 8 weeks (Ps <0.01, all), and benefits were retained at 1 year (Ps<0.05, all). Initial symptom reductions in the Health Education group were smaller and not sustained. Comparisons to the waitlist confirmed the impact of MBSR on both symptoms and quality of life, whereas Health Education improvements were limited to quality of life ratings.
Conclusions
MBSR reduced distressing symptoms of anxiety, depression and poor sleep and improved quality of life. Benefits were sustained over 1 year. A health education program provided fewer benefits, and effects were not as durable. MBSR is a relatively inexpensive, safe and effective community-based intervention.
PMCID: PMC3076132  PMID: 20882729
12.  Wet cupping therapy for treatment of herpes zoster: a systematic review of randomized controlled trials 
Background
Wet cupping is a traditional Chinese medicine therapy commonly used in treating herpes zoster in China, and clinical studies have shown that wet cupping may have beneficial effect on herpes zoster compared with western medication.
Methods
We included randomized controlled trials on wet cupping for herpes zoster. We searched PubMed, the Cochrane Library (Issue 3, 2008), China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wan Fang Database. All searches ended in February 2009. Two authors extracted data and assessed the trials quality independently. RevMan 5.0.18 software was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI).
Results
8 RCTs involving 651 patients were included, and the methodological quality of trials was generally fair in terms of randomization, blinding and intention-to-treat analysis. Meta-analyses showed wet cupping was superior to medications regarding the number of cured patients (RR 2.49, 95%CI 1.91 to 3.24, p<0.00001), the number of patients with improved symptoms (RR 1.15, 95%CI 1.05 to 1.26, p=0.003), and reducing the incidence rate of postherpetic neuralgia (RR 0.06, 95%CI 0.02 to 0.25, p=0.0001). Wet cupping plus medications was significantly better than medications alone on number of cured patients (RR 1.93, 95%CI 1.23 to 3.04, p=0.005), but no difference in symptom improvement (RR 1.00, 95%CI 0.92 to 1.08, p=0.98). There were no serious adverse effects with related to wet cupping therapy in the included trials.
Conclusions
Wet cupping appears to be effective in treatment of herpes zoster. However, further large, rigorous designed trials are warranted.
PMCID: PMC3151529  PMID: 21280462
13.  MINDFUL AWARENESS IN BODY-ORIENTED THERAPY FOR FEMALE VETERANS WITH POST-TRAUMATIC STRESS DISORDER TAKING PRESCRIPTION ANALGESICS FOR CHRONIC PAIN: A FEASIBILITY STUDY 
Context
Preliminary studies of body therapy for women in trauma recovery suggest positive results but are not specific to women with post-traumatic stress disorder (PTSD) and chronic pain.
Objective and Participants
To examine the feasibility and acceptability of body-oriented therapy for female veterans with PTSD and chronic pain taking prescription analgesics.
Design and Setting
A 2-group, randomized, repeated-measures design was employed. Female veterans (N=14) were recruited from a Veterans Affairs (VA) healthcare system in the Northwest United States (VA Puget Sound Health Care System, Seattle, Washington). Participants were assigned to either treatment as usual (TAU) or treatment as usual and 8 weekly individual body-oriented therapy sessions (mindful awareness in body-oriented therapy group).
Measures
Written questionnaires and interviews were used assess intervention acceptability; reliable and valid measures were administered at 3 time points to evaluate measurement acceptability and performance; and within-treatment process measures and a participant post-intervention questionnaire assessed treatment fidelity.
Intervention
A body-oriented therapy protocol, “Mindful Awareness in Body-oriented Therapy” (MABT) was used. This is a mind-body approach that incorporates massage, mindfulness, and the emotional processing of psychotherapy.
Results
Over 10 weeks of recruitment, 31 women expressed interest in study participation. The primary reason for exclusion was the lack of prescription analgesic use for chronic pain. Study participants adhered to study procedures, and 100% attended at least 7 of 8 sessions; all completed in-person post-treatment assessment. Written questionnaires about intervention experience suggest increased tools for pain relief/relaxation, increased body/mind connection, and increased trust/safety. Ten of 14 responded to mailed 3-month follow-up. The response-to-process measures indicated the feasibility of implementing the manualized protocol and point to the need for longer sessions and a longer intervention period with this population.
PMCID: PMC3037268  PMID: 17985809
14.  CEREBROSPINAL FLUID STASIS AND ITS CLINICAL SIGNIFICANCE 
We hypothesize that stasis of the cerebrospinal fluid (CSF) occurs commonly and is detrimental to health. Physiologic factors affecting the normal circulation of CSF include cardiovascular, respiratory, and vasomotor influences. The CSF maintains the electrolytic environment of the central nervous system (CNS), influences systemic acid-base balance, serves as a medium for the supply of nutrients to neuronal and glial cells, functions as a lymphatic system for the CNS by removing the waste products of cellular metabolism, and transports hormones, neurotransmitters, releasing factors, and other neuropeptides throughout the CNS. Physiologic impedance or cessation of CSF flow may occur commonly in the absence of degenerative changes or pathology and may compromise the normal physiologic functions of the CSF. CSF appears to be particularly prone to stasis within the spinal canal. CSF stasis may be associated with adverse mechanical cord tension, vertebral subluxation syndrome, reduced cranial rhythmic impulse, and restricted respiratory function. Increased sympathetic tone, facilitated spinal segments, dural tension, and decreased CSF flow have been described as closely related aspects of an overall pattern of structural and energetic dysfunction in the axial skeleton and CNS. Therapies directed at affecting CSF flow include osteopathic care (especially cranial manipulation), craniosacral therapy, chiropractic adjustment of the spine and cranium, Network Care (formerly Network Chiropractic), massage therapy (including lymphatic drainage techniques), yoga, therapeutic breathwork, and cerebrospinal fluid technique. Further investigation into the nature and causation of CSF stasis, its potential effects upon human health, and effective therapies for its correction is warranted.
PMCID: PMC2842089  PMID: 19472865
15.  YOGA FOR CHRONIC LOW BACK PAIN IN A PREDOMINANTLY MINORITY POPULATION: A PILOT RANDOMIZED CONTROLLED TRIAL 
Background
Several studies suggest yoga may be effective for chronic low back pain; however, trials targeting minorities have not been conducted.
Primary Study Objectives
Assess the feasibility of studying yoga in a predominantly minority population with chronic low back pain. Collect preliminary data to plan a larger powered study.
Study Design
Pilot randomized controlled trial.
Setting
Two community health centers in a racially diverse neighborhood of Boston, Massachusetts.
Participants
Thirty English-speaking adults (mean age 44 years, 83% female, 83% racial/ethnic minorities; 48% with incomes ≤$30000) with moderate-to-severe chronic low back pain.
Interventions
Standardized series of weekly hatha yoga classes for 12 weeks compared to a waitlist usual care control.
Outcome Measures
Feasibility measured by time to complete enrollment, proportion of racial/ethnic minorities enrolled, retention rates, and adverse events. Primary efficacy outcomes were changes from baseline to 12 weeks in pain score (0=no pain to 10=worst possible pain) and back-related function using the modified Roland-Morris Disability Questionnaire (0–23 point scale, higher scores reflect poorer function). Secondary efficacy outcomes were analgesic use, global improvement, and quality of life (SF-36).
Results
Recruitment took 2 months. Retention rates were 97% at 12 weeks and 77% at 26 weeks. Mean pain scores for yoga decreased from baseline to 12 weeks (6.7 to 4.4) compared to usual care, which decreased from 7.5 to 7.1 (P=.02). Mean Roland scores for yoga decreased from 14.5 to 8.2 compared to usual care, which decreased from 16.1 to 12.5 (P=.28). At 12 weeks, yoga compared to usual care participants reported less analgesic use (13% vs 73%, P=.003), less opiate use (0% vs 33%, P=.04), and greater overall improvement (73% vs 27%, P=.03). There were no differences in SF-36 scores and no serious adverse events.
Conclusion
A yoga study intervention in a predominantly minority population with chronic low back pain was moderately feasible and may be more effective than usual care for reducing pain and pain medication use.
PMCID: PMC2792123  PMID: 19943573
16.  RELATIONSHIPS AMONG OLDER PATIENTS, CAM PRACTITIONERS, AND PHYSICIANS: THE ADVANTAGES OF QUALITATIVE INQUIRY 
Older patients are increasingly likely to be under the simultaneous care of both physicians and alternative practitioners, often for treatment of the same condition. In the majority of cases, however, alternative care is not integrated with biomedical care; indeed, most patients do not inform their physicians of their concurrent use of complementary and alternative medicine (CAM). Because of the increased use of CAM in recent years, this is a critical juncture at which to study healthcare relationships in which the patient is treated by practitioners from different medical systems who are usually not in contact with and often not aware of one another. The purpose of this paper is to (a) review the limited literature that addresses healthcare relationships among patients, physicians, and alternative practitioners; (b) suggest that understanding all 3 sides of the patient-physician-CAM practitioner triangle creates a more comprehensive and realistic view of current healthcare practices; and (c) propose that qualitative research methodologies can provide unique and essential understandings of these emerging healthcare relationship configurations. An ongoing qualitative research study of older women with breast cancer and their interactions with their physicians and alternative practitioners is described as an example.
PMCID: PMC2754707  PMID: 12622050
17.  ASSOCIATION OF COMPLEMENTARY AND ALTERNATIVE MEDICINE USE WITH HIGHLY ACTIVE ANTIRETROVIRAL THERAPY INITIATION 
Objective
To assess whether complementary and alternative medicine (CAM) use is associated with the timing of highly active antiretroviral therapy (HAART) initiation among human immunodeficiency virus (HIV)–infected participants of the Women’s Interagency HIV Study.
Study Methods
Prospective cohort study between January 1996 and March 2002. Differences in the cumulative incidence of HAART initiation were compared between CAM users and non–CAM users using a logrank test. Cox regression model was used to assess associations of CAM exposures with time to HAART initiation.
Main Outcome and Exposures
Study outcome was time from January 1996 to initiation of HAART. Primary exposure was use of any CAM modality before January 1996, and secondary exposures included the number and type of CAM modalities used (ingestible CAM medication, body practice, or spiritual healing) during the same period.
Results
One thousand thirty-four HIV-infected women contributed a total of 4987 person-visits during follow-up. At any time point, the cumulative incidence of HAART initiation among CAM users was higher than that among non–CAM users. After adjustment for potential confounders, those reporting CAM use were 1.34 times (95% confidence interval: 1.09, 1.64) more likely to initiate HAART than non–CAM users.
Conclusion
Female CAM users initiated HAART regimens earlier than non–CAM users. Initiation of HAART is an important clinical marker, but more research is needed to elucidate the role specific CAM modalities play in HIV disease progression.
PMCID: PMC2651402  PMID: 18780580
18.  RANDOMIZED, CONTROLLED, SIX-MONTH TRIAL OF YOGA IN HEALTHY SENIORS: EFFECTS ON COGNITION AND QUALITY OF LIFE 
Context
There are potential benefits of mind-body techniques on cognitive function because the techniques involve an active attentional or mindfulness component, but this has not been fully explored.
Objective
To determine the effect of yoga on cognitive function, fatigue, mood, and quality of life in seniors.
Design
Randomized, controlled trial comparing yoga, exercise, and wait-list control groups.
Participants
One hundred thirty-five generally healthy men and women aged 65–85 years.
Intervention
Participants were randomized to 6 months of Hatha yoga class, walking exercise class, or wait-list control. Subjects assigned to classes also were asked to practice at home.
Main Outcome Measures
Outcome assessments performed at baseline and after the 6-month period included a battery of cognitive measures focused on attention and alertness, the primary outcome measures being performance on the Stroop Test and a quantitative electroencephalogram (EEC) measure of alertness; SF-36 health-related quality of life; Profile of Mood States; Multi-Dimensional Fatigue Inventory; and physical measures related to the interventions.
Results
One hundred thirty-five subjects were recruited and randomized. Seventeen subjects did not finish the 6-month intervention. There were no effects from either of the active interventions on any of the cognitive and alertness outcome measures. The yoga intervention produced improvements in physical measures (eg, timed 1-legged standing, forward flexibility) as well as a number of quality-of-life measures related to sense of well-being and energy and fatigue compared to controls.
Conclusions
There were no relative improvements of cognitive function among healthy seniors in the yoga or exercise group compared to the wait-list control group. Those in the yoga group showed significant improvement in quality-of-life and physical measures compared to exercise and wait-list control groups.
PMCID: PMC1457100  PMID: 16454146
19.  A NON-DAIRY PROBIOTIC’S (POI) INFLUENCE ON CHANGING THE GASTROINTESTINAL TRACT’S MICROFLORA ENVIRONMENT 
Justification
Yogurt has been historically used to restore gut microflora adversely affected by antibiotic treatment. Certain fermented dairy products are probiotics; “live microorganisms which when administered in adequate amounts confer a health benefit to the host.” Microorganisms in foods may benefit certain health conditions such as diarrhea, gastroenteritis, irritable bowel syndrome, inflammatory bowel disease, and cancer. A potential new probiotic from a Polynesian traditional food is poi; a starchy paste made from the corm of taro plants.
Objective
The purpose of this study was to determine if consumption of poi, a potential non-dairy probiotic, altered the microflora in the gastrointestinal tract of healthy adults.
Methods
A cross-over clinical study included 18 subjects (19–64 years of age) divided into a poi group (n=10) and control group (n=8). The study duration of 14 weeks consisted of a 2-week washout, 4-week treatment or control, a subsequent 2-week washout, cross-over of 4-week treatment or control, and a final 2-week washout. Subjects thus served as their own controls. While receiving the poi treatment, participants consumed fresh poi (1–2 days old) three times a day (130 g/meal or about _ cup/meal); the control group did not. Both groups filled out 3-day dietary records to ensure compliance. Measurable outcomes include pre-and post-treatment microbiological fecal culture analyses.
Results
We found no significant differences in total bacterial counts following a poi diet versus following a control diet, nor were significant differences found in counts of specific bacterial species. Lactococcus tends to be higher in poi when it is analyzed for specific bacteria, but the poi consumption in our study did not alter the mean concentration of individual bacterial species (log10 CFU/g wet feces) for Escherichia coli, Enterobacter, Klebsiella, Lactobacillus, Lactococcus, and Bifidobacterium. No significant differences in stool frequency or consistency were observed between the treatment and control group periods.
Conclusion
Poi consumption did not significantly alter total or individual bacterial counts in the human gastrointestinal tract. Further research might determine if “sour poi” (3–4 days old) has a greater affect than “fresh poi” (1–2 days old) as a potential probiotic, and a larger trial with longer diet durations may detect more subtle effects of poi consumption on bacterial counts.
PMCID: PMC1364477  PMID: 15712767
20.  PATTERNS OF DIETARY SUPPLEMENT USAGE IN DEMOGRAPHICALLY DIVERSE OLDER PEOPLE 
Objective
To analyze dietary supplement usage data from 494 older adults, aged 65 to 101 years.
Setting
Community dwellers living independently of institutionalized care.
Design
All dietary supplements, including botanicals, were recorded to aid in assessing the health status of older adults.
Participants
1) 224 individuals enrolled in a study that follows the health of persons 85 years and older (oldest-old) in Klamath County, a non-metropolitan area in southern Oregon: 2) 134 participants of oldest-old age living in the metropolitan Portland area, enrolled in a randomized clinical trial of GBE biloba extract (GBE) for dementia prevention: and 3) 136 participants, ages 65–85 years (young-old), also of the Portland area, enrolled in a study of the effects of yoga and exercise on cognition.
Measurements
Data verified from labels, not from self-report.
Results
Of the participants, 70.6% used dietary supplements. Women took supplements more often than men, and usage decreased with age. A greater percentage, 67.4%, of the non-metropolitan oldest-old took supplements, compared to 56.7% of the metropolitan oldest-old. The greatest usage, 89.7%, was in the metropolitan young-olds. All of these percentages exceed those for comparable age groups in national representative surveys.
Conclusions
Dietary supplement usage by older adults in these studies in Oregon exceeded that in other reports and may reflect high interest in complementary and alternative medicine. This report confirms the results of other studies showing that elderly adults, particularly women, use dietary supplements more than other segments of the US population. Researchers and clinicians should be aware of this pattern and potential conflicts with research design or treatment regimen intended for older people.
PMCID: PMC1255934  PMID: 15945136
21.  BODY-ORIENTED THERAPY IN RECOVERY FROM CHILD SEXUAL ABUSE: AN EFFICACY STUDY 
Context
There has been little research on body therapy for women in sexual abuse recovery. This study examines body-oriented therapy—an approach focused on body awareness and involving the combination of bodywork and the emotional processing of psychotherapy.
Objective
To examine the efficacy and the perceived influence on abuse recovery of body-oriented therapy. Massage therapy served as a relative control condition to address the lack of touch-based comparisons in bodywork research.
Design
A 2-group, repeated measures design was employed, involving randomization to either body-oriented therapy or massage group, conducted in 8, hour-long sessions by 1 of 4 research clinicians. Statistical and qualitative analysis was employed to provide both empirical and experiential perspectives on the study process.
Setting
Participants were seen in treatment rooms of a university in the northwestern United States and in clinician’s private offices.
Participants
Twenty-four adult females in psychotherapy for child sexual abuse.
Interventions
Body-oriented therapy protocol was delivered in three stages, involving massage, body awareness exercises, and inner-body focusing process. Massage therapy protocol was stan- dardized. Both protocols were delivered over clothes.
Main Outcome Measures
The outcomes reflected 3 key con-structs—psychological well being, physical well-being, and body connection. Repeated measures included: Brief Symptom Inventory, Dissociative Experiences Scale, Crime-Related Post Traumatic Stress Disorder Scale, Medical Symptoms Checklist, Scale of Body Connection and Scale of Body Investment. Results were gathered at 6 time points: baseline, 2 times during intervention, post-intervention, and at 1 month and 3 months follow-up. To examine the experiential perspective of the study process, written questionnaires were administered before and after intervention and at 1 month and 3 months follow-up.
Results
Repeated measures analysis of variance (ANOVA) indicated significant improvement on all outcome measures for both intervention groups, providing support for the efficacy of body therapy in recovery from childhood sexual abuse. There were no statistically significant differences between groups; however, qualitative analysis of open-ended questions about participant intervention experience revealed that the groups differed on perceived experience of the intervention and its influence on therapeutic recovery.
PMCID: PMC1933482  PMID: 16189948

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