Living in the epilepsy treatment gap in rural South India: A focused ethnography of women and problems associated with stigma.

In India, women with epilepsy face unique challenges. A focused ethnography of six women within the epilepsy treatment gap was conducted in rural South India. Women were asked to describe their day-to-day lives. Data were collected through open-ended, semistructured interview questions, participant observation, and field notes. Thematic analysis was done. The disease-related stigma contributed to the women's physical, psychological, and emotional struggles; the women and their family members made every effort to conceal the disease. Educational interventions to create awareness could help women seek effective treatments for their seizures, thereby reducing the stigma and improving the quality of their lives.

Effects of n-3 fish oil on metabolic and histological parameters in NASH: a double-blind, randomized, placebo-controlled trial.

BACKGROUND & AIMS: This study's aim was to assess the histological and metabolic effects of n-3 polyunsaturated fatty acids (PUFAs) vs. placebo while adjusting for the impact of age and weight change in NASH patients. (ClinicalTrials.gov: NCT00681408). METHODS: Forty-one subjects with non-cirrhotic NASH were enrolled, and 34 completed the study. 17 received n-3 fish oil 3000 mg/day and 17 received placebo daily for 1 year with typical counselling on caloric intake and physical activity for all subjects. RESULTS: N-3- and placebo-treated groups showed no significant difference for the primary end point of NASH activity score (NAS) reduction ⩾ 2 points without fibrosis progression after adjustment for known covariates (n-3, 4/17 (23.5%); placebo, 3/17, (17.6%), p = 0.99). Among subjects with increased or stable weight, n-3 subjects showed a larger decrease in liver fat content by MRI than placebo-treated subjects (p = 0.014 for 2nd quartile, p = 0.003 for 3rd quartile of weight change). N-3 treatment showed significant fat reduction on the paired analysis of image-assisted fat morphometry regardless of weight loss or gain. Exercise capacity remained markedly reduced in all subjects. No independent effects on markers of hepatocyte injury or insulin sensitivity indices were observed. CONCLUSION: N-3 PUFAs at 3000 mg/day for one year did not lead to an improvement in the primary outcome of histological activity in NASH patients (⩾ 2 point NAS reduction). N-3 led to reduced liver fat by multiple measures. Other metabolic effects were not seen, although no detrimental effects were apparent. Whether longer duration, higher dose, or different composition of n-3 therapy would lead to additional benefits is uncertain.

A high-fiber diet may improve bowel function and health-related quality of life in patients with Crohn disease.

Crohn disease is a chronic disorder characterized by episodes of epithelial inflammation in the gastrointestinal tract for which there is no cure. The prevalence of Crohn disease increased in civilized nations during the time period in which food sources were industrialized in those nations. A characteristic of industrialized diets is the conspicuous absence of cereal fiber. The purpose of this 2-group, randomized, controlled study was to investigate the effects of fiber-related dietary instructions specifying wheat bran consumption on health-related quality of life and gastrointestinal function in individuals diagnosed with Crohn disease, as measured by the Inflammatory Bowel Disease Questionnaire and the partial Harvey Bradshaw Index, respectively. Results demonstrated that consuming a wheat bran-inclusive diet was feasible and caused no adverse effects, and participants consuming whole wheat bran in the diet reported improved health-related quality of life (p = .028) and gastrointestinal function (p = .008) compared to the attention control group. The results of a secondary aim, to investigate differences in measures of systemic inflammation, found no group differences in C-reactive protein or erythrocyte sedimentation rates. This study suggests that diet modification may be a welcomed complementary therapy for individuals suffering gastrointestinal disruption associated with Crohn disease.

Cranial electrical stimulation improves symptoms and functional status in individuals with fibromyalgia.

To investigate the effects of microcurrent cranial electrical stimulation (CES) therapy on reducing pain and its associated symptoms in fibromyalgia (FM), we conducted a randomized, controlled, three-group (active CES device, sham device, and usual care alone [UC]), double-blind study to determine the potential benefit of CES therapy for symptom management in FM. Those individuals using the active CES device had a greater decrease in average pain (p = .023), fatigue (p = .071), and sleep disturbance (p = .001) than individuals using the sham device or those receiving usual care alone over time. Additionally, individuals using the active CES device had improved functional status versus the sham device and UC groups over time (p = .028).

No stone left unturned: challenges encountered during recruitment of women with advanced ovarian cancer for a phase I study.

The recruitment and accrual of participants for cancer clinical trial research is often challenging. Chronic low accrual rates negatively influence the findings and generalizability that can be drawn from the available pool of research. There is a need for further evidence regarding both unsuccessful and successful approaches and useful strategies that investigators have used to counter common recruitment challenges. During recruitment for an intervention study examining the safety, efficacy, and feasibility of a potentially novel supportive therapy, a variety of steps were taken to avoid and subsequently overcome potential and real recruitment challenges the investigators faced. In this article the authors provide an overview of common recruitment challenges as well as the actual challenges encountered, procedures and strategies implemented to counter these challenges, while investigating the combined intervention of flaxseed oil, fasting, caffeine, and exercise in women with recurrent or multi-drug resistant stage III or IV ovarian cancer.

Feasibility, acceptability, and effects of gentle Hatha yoga for women with major depression: findings from a randomized controlled mixed-methods study.

Major depressive disorder (MDD) is a common, debilitating chronic condition in the United States and worldwide. Particularly in women, depressive symptoms are often accompanied by high levels of stress and ruminations, or repetitive self-critical negative thinking. There is a research and clinical imperative to evaluate complementary therapies that are acceptable and feasible for women with depression and that target specific aspects of depression in women, such as ruminations. To begin to address this need, we conducted a randomized, controlled, mixed-methods community-based study comparing an 8-week yoga intervention with an attention-control activity in 27 women with MDD. After controlling for baseline stress, there was a decrease in depression over time in both the yoga group and the attention-control group, with the yoga group having a unique trend in decreased ruminations. Participants in the yoga group reported experiencing increased connectedness and gaining a coping strategy through yoga. The findings provide support for future large scale research to explore the effects of yoga for depressed women and the unique role of yoga in decreasing rumination.

"A feeling of connectedness": perspectives on a gentle yoga intervention for women with major depression.

Major depressive disorder (MDD) is one of the most common and debilitating health conditions in women in the United States and worldwide. Many women with MDD seek out complementary therapies for their depressive symptoms, either as an adjunct or alternative to the usual care. The purpose of this study is to understand the experiences of women who participated in a yoga intervention for their depression. The findings from this interpretive phenomenological study are derived from interviews with and daily logs by 12 women with MDD who took part in an 8-week gentle yoga intervention as part of a larger parent randomized, controlled trial. Results show that the women's experience of depression involved stress, ruminations, and isolation. In addition, their experiences of yoga were that it served as a self-care technique for the stress and ruminative aspects of depression and that it served as a relational technique, facilitating connectedness and shared experiences in a safe environment. Future long-term research is warranted to evaluate these concepts as potential mechanisms for the effects of yoga for depression.

Dietary fiber information for individuals with Crohn disease: reports of gastrointestinal effects.

The experiences of individuals with Crohn disease before and after receiving dietary fiber information have not been described in the literature. This article offers findings from a study that used four semistructured audiorecorded interviews during a 4-week time period for the purpose of exploring the experiences of 11 individuals before and after receiving dietary fiber information from a healthcare professional. The first and second interviews occurred immediately before and after the presentation of information. Follow-up interviews occurred at 2-week intervals. Thematic analysis of the baseline interviews revealed 2 themes: (a) accepting a redefined (lower expectations) definition of normal quality of life and (b) continuing to look for answers. Three themes emerged from the follow-up interviews at Week 4: (a) reevaluating old diet-related concepts, (b) enjoying a healthier lifestyle at a self-set pace, and (c) enjoying positive physical effects of wheat bran consumption. This article examines the 3rd postintervention theme, "enjoying physical effects of wheat bran consumption." The relevance of this research is that nurses equipped with dietary fiber information may be better able to help some individuals with Crohn disease to explore the potential benefits of a well-rounded nutritious pattern of eating that includes wheat bran cereal.

Fire in the belly and the professionalization of nurses: a historical analysis of Crohn disease care.

Today, professional nurses around the world are stepping up to meet the needs of individuals with Crohn disease, using their specialized knowledge and skills that demonstrate areas of expertise that have not always existed. The gastrointestinal-specific knowledge being used by these 21st-century nurses exists today because progressive efforts of nurses in previous decades moved the profession of nursing forward. The purpose of this article was to describe and analyze the development of the role of nurses in responding to new challenges patients with Crohn disease face since the emergence of the disease in the early 20th century. The authors used traditional historic research methods to conduct the study. Primary sources include nursing journals and textbooks published in the 20th and 21st centuries and documents archived at The Mount Sinai Hospital in New York City, where Burrill B. Crohn conducted his seminal work. The significance of the findings is that the changing role of nurses in caring for patients with Crohn disease mirrors the professionalization of nursing during the 20th and early 21st centuries.

Use of complementary therapies by individuals with or at risk for cardiovascular disease: results of the 2007 National Health Interview Survey.

BACKGROUND: Complementary and alternative medicine (CAM) therapies are often used as adjuvants to conventional treatment by individuals with cardiovascular disease (CVD) or CVD risk factors, such as hypertension and high cholesterol. Patterns of use of CAM practices and products represent important data for health care providers in delivering adequate patient care. OBJECTIVE: This study compared CAM use among the US CVD and general population, as well as individuals with CVD risk factors (hypertension and/or high cholesterol), through secondary analyses of the 2007 National Health Interview Survey data. METHODS: The analysis compared use of CAM by individuals with CVD (those individuals self-reporting a diagnosis of coronary heart disease; n = 1055), individuals with CVD risk factors (those individuals self-reporting a diagnosis of hypertension [n = 6849] or high cholesterol [n = 5808]), and individuals who self-report as not having CVD or CVD risk factors (n = 22 290). RESULTS: Use of complementary practices and products by patients with CVD and CVD risk factors is common and significantly greater than individuals without CVD in the general population. The most common categories of complementary modalities used by individuals with a self-reported diagnosis of CVD or CVD risk factors were natural products and mind-body practices. CONCLUSIONS: The diagnosis of CVD or CVD risk factors may be associated with the use of complementary practices and products.

Chiropractic use, health care expenditures, and health outcomes for rural and nonrural individuals with arthritis.

OBJECTIVE: Arthritis is considered the leading cause of disability among adults in the United States today and contributes substantially to the rising cost of health care. Residents of rural areas are especially affected. The purposes of this article are to describe chiropractic use by rural and nonrural individuals with arthritis and to identify differences in other health care use and health status by those using chiropractic care plus conventional care or conventional care alone. METHODS: A longitudinal cohort from panel 12 (N = 12440) of the Medical Expenditure Panel Survey spanning 2007 to 2008 was selected for this study to represent changes in health care expenditures and use and outcomes throughout this period. The population was stratified by self-reported physician-diagnosed arthritis and rural status and compared across demographics, health status, and health care use and expenditures, including use of chiropractic services plus conventional care or conventional care alone. RESULTS: Twice as many rural people with arthritis had 1 or more visits with a doctor of chiropractic compared with nonrural persons with arthritis. More rural chiropractic users with arthritis reported their perceived health status as excellent, very good, or good compared with nonrural chiropractic users with arthritis and to rural people with arthritis who reported no chiropractic visits. Health care expenditures for other physician services were higher among rural chiropractic users with arthritis than nonrural users with arthritis. CONCLUSIONS: Differences in chiropractic use were observed between rural and nonrural individuals with arthritis. More studies are needed to investigate these differences and the impact on health care use and expenditures and outcomes of individuals with arthritis.

A complementary care study combining flaxseed oil, caffeine, fasting, and exercise in women diagnosed with advanced ovarian cancer: findings from a case study.

This article presents the experiences of 1 participant with advanced ovarian cancer enrolled in a proof of concept complementary therapy study evaluating the effects of a combined intervention of flaxseed oil, fasting, caffeine, and exercise. Improvements were observed in physical and psychological symptoms. The participant adopted positive lifestyle modifications.

Biofield therapies in cardiovascular disease management: a brief review.

Though there have been advances over the last 30 years in the therapeutic approaches to cardiovascular disease (CVD), heart disease and stroke remain the leading cause of mortality and morbidity worldwide. Many medical therapies for CVD are associated with a number of side effects, often leading patients to seek non-pharmacological treatments to complement standard care. Referred to as complementary and alternative medicine (CAM), these therapies consist of a heterogeneous group of modalities used in addition to conventional health care. Biofield therapies exist within this CAM domain and involve the direction of healing energy to facilitate general health and well-being by modifying the energy field. What follows is a brief overview of three biofield therapies developed or used within the field of nursing (Therapeutic Touch, Reiki, and Healing Touch), surveying the use of these interventions for individuals with CVD, and outcomes that may impact CVD risk factors and health-related quality of life.

Pilot feasibility study of binaural auditory beats for reducing symptoms of inattention in children and adolescents with attention-deficit/hyperactivity disorder.

INTRODUCTION: The purpose of this pilot study was to explore the potential for the use of binaural auditory beat stimulation to reduce the symptom of inattention in children and adolescents with attention-deficit/hyperactivity disorder. METHODS: This pilot study had a randomized, double-blind, placebo-controlled design. Twenty participants were randomly assigned to listen to either an audio program on compact disk that contained binaural auditory beats or a sham audio program that did not have binaural beats for 20 minutes, three times a week for 3 weeks. The Children's Color Trails Test, the Color Trails Test, the Test of Variables of Attention (TOVA), and the Homework Problem Checklist were used to measure changes in inattention pre- and postintervention. RESULTS: Repeated measures analysis of variance was used to analyze pre- and postintervention scores on the Color Trails Tests, Homework Problem Checklist, and the TOVA. The effect of time was significant on the Color Trails Test. However, there were no significant group differences on the Color Trails Test or the TOVA scores postintervention. Parents reported that the study participants had fewer homework problems postintervention. DISCUSSION: The results from this study indicate that binaural auditory beat stimulation did not significantly reduce the symptom of inattention in the experimental group. However, parents and adolescents stated that homework problems due to inattention improved during the 3-week study. Parents and participants stated that the modality was easy to use and helpful. Therefore, this modality should be studied over a longer time frame in a larger sample to further its effectiveness to reduce the symptom of inattention in those diagnosed with attention-deficit/hyperactivity disorder.

Effects of cranial electrical stimulation on sleep disturbances, depressive symptoms, and caregiving appraisal in spousal caregivers of persons with Alzheimer's disease.

PURPOSE: The purpose of this work was to investigate the effects of cranial electrical stimulation (CES) on sleep disturbances, depressive symptoms, and caregiving appraisal. METHODS: Thirty-eight participants were randomly assigned to receive active CES or sham CES for 4 weeks. RESULTS: Both intervention groups demonstrated improvement in study measures from baseline scores. A trend toward statistically significant differences in daily sleep disturbances was found between the groups. No differences in depressive symptoms and caregiving appraisal were found between the groups. CONCLUSIONS: These findings did not fully support the efficacy of the short-term use of active CES versus sham CES to improve sleep disturbances, depressive symptoms, or caregiving appraisal.

Acupuncture and osteoarthritis of the knee: a review of randomized, controlled trials.

Osteoarthritis of the knee is a major cause of disability among adults. Treatment is focused on symptom management, with nonpharmacologic therapies being the preferred first line of treatment. Acupuncture is considered a potentially useful treatment for osteoarthritis. The objective of this article is to review the English-language articles, indexed in MEDLINE or CINAHL, describing randomized, controlled trials of the effects of needle or electroacupuncture on knee osteoarthritis. Ten trials representing 1456 participants met the inclusion criteria and were analyzed. These studies provide evidence that acupuncture is an effective treatment for pain and physical dysfunction associated with osteoarthritis of the knee.

Stress management during pregnancy: designing and evaluating a mind-body intervention.

The objective of this 12-week study was to determine whether a relaxation-guided imagery (R-GI) intervention designed as a primary prevention strategy for stress management was perceived as beneficial to African American women during the second trimester of pregnancy. All participants documented perceived benefits of the R-GI intervention that included the following: (1) improved breathing; (2) ability to relax, clear one's mind, and become calm; (3) ability to channel and decrease stress; (4) release of anxiety; (5) use of R-GI throughout the day helped control anger and state of mind, leading to a smoother day; and (6) improved ability to fall and stay asleep.

Contextualizing the effects of yoga therapy on diabetes management: a review of the social determinants of physical activity.

This article provides a review of literature both to identify the effects of yoga-based therapy on the management of type 2 diabetes mellitus and to examine the social context of physical activity. Findings from the review indicate that yoga has a positive short-term effect on multiple diabetes-related outcomes; however, long-term effects of yoga therapy on diabetes management remain unclear. The context of the social environment, including interpersonal relationships, community characteristics, and discrimination, influences the adoption and maintenance of health behaviors such as physical activity, including yoga practice. Further research is necessary to determine the extent of this influence.

Cranial electrical stimulation: potential use in reducing sleep and mood disturbances in persons with dementia and their family caregivers.

Family caregivers of persons with dementia and their care recipients frequently experience sleep and mood disturbances throughout their caregiving and disease trajectories. Because conventional pharmacologic treatments of sleep and mood disturbances pose numerous risks and adverse effects to elderly persons, the investigation of other interventions is warranted. As older adults use complementary and alternative medicine interventions for the relief of sleep and mood disturbances, cranial electrical stimulation, an energy-based complementary and alternative medicine, may be a viable intervention. The proposed mechanism of action and studies that support cranial electrical stimulation as a modality to reduce distressing symptoms are reviewed. Directions for research are proposed.

Family interactions among African American prostate cancer survivors.

Prostate cancer affects African Americans at a higher rate than any other ethnic group in the United States. Prostate cancer does not only affect the man with the disease but also affects those individuals who are closest to him, such as his family and friends. Open communication is valuable in coping with stressors that are affiliated with chronic illnesses. This article focuses on family and friend social support of men with prostate cancer. Data analysis revealed that support from family members and friends plays an important role in how men cope with their treatment and recovery from prostate cancer.