Symptoms associated with teething and response to three treatments, including homeopathic medicine: a multicenter prospective observational study among 190 French pediatricians.

BACKGROUND: Primary tooth eruption in infants is associated with a range of local and systemic symptoms although this remains a subject of much debate. In addition, data are limited on the role of physicians in managing infant teething, and on the benefit of homeopathic treatments. METHODS: We conducted an observational, multicenter, prospective survey evaluating teething symptoms, and symptom course following routine medical management by French pediatricians in 597 infants aged from 3 to 24 months. We also examined the response to treatment with routinely prescribed teething medications; the homeopathic agent, Camilia® and topically applied gingival agents (Delabarre® or Dolodent®). RESULTS: Most infants (96.6%) had buccogingival symptoms and 93.3% had at least one general symptom. Fever (≥38 °C) was reported in 15.2% of infants. For teething, 212 infants were prescribed Camilia®, 172 a gingival solution (Delabarre® or Dolodent®) and 213 received Camilia® along with a gingival agent. Infants prescribed both a homeopathic and a gingival treatment had a significantly higher number of symptoms at presentation compared with those prescribed a single agent. There were no significant differences in symptom course across these three treatment groups. Systemic analgesics/antipyretics were prescribed in 68.8% of cases. Parent satisfaction with medical management and prescribed treatments was high. CONCLUSIONS: Teething is frequently associated with transient local and systemic upset in infants and is a significant concern to parents. Camilia® provides a similar benefit to topical therapy, and is frequently used by pediatricians in France.

Informing the homeopathic practice for Turkish pharmacists: reviewing the example of Portuguese community pharmacies.

INTRODUCTION: Alternative and complementary therapy systems, such as homeopathy, have long been used around the world. Since 1995 homeopathy has been officially recognized in Europe as a system of medicine or a medical specialty. Portuguese community pharmacists have long-standing experience with homeopathic products. By contrast, healthcare professionals in Turkey are less experienced with homeopathic practice although there is a new regulatory setting in place. There are a limited number of studies addressing pharmacists' role within the homeopathic system. AIM: To investigate the attitudes (knowledge, feelings and behaviour) of experienced Portuguese pharmacy practitioners who deal with homeopathy, and thus to inform Turkish pharmacy practice and policy on homeopathy-related success factors. METHODS: A qualitative cross-sectional design was followed, using semi-structured and face-to-face individual interviews with purposively selected Portuguese pharmacists experienced with homeopathic medicines. Audio-recordings were transcribed verbatim and the transcriptions imported into QSR NVivo v10 software for qualitative coding and analysis. Using a thematic content approach, the extracted codes were grouped and indexed by recurrent themes through a reflective procedure and constant comparison. RESULTS & DISCUSSION: Six general themes emerged, the most relevant being participants' feelings of gratitude for the ability to work in homeopathy; other themes were a helpful regulatory body, clear practice boundaries, scientific support and product quality assurance. Specialized homeopathic education was considered the most important factor for success. This was related to patients' positive perceptions and acceptance, suggesting an increase in public awareness through the pharmacy network. CONCLUSIONS: Portuguese pharmacists' attitudes towards their homeopathic practices highlighted the key elements for success in a field that is usually distant from traditional pharmaceutical education and practice. The present findings provide guidance for Turkish pharmacists willing to expand their professional scope and to embrace complementary medicines.

[Complementary and alternative medicine in the German outpatient setting: extent, structure and reasons for provision]. / Komplementäre und alternative Heilverfahren im vertragsärztlichen Bereich: Ausmaß, Struktur und Gründe des ärztlichen Angebots.

BACKGROUND: Research on complementary and alternative medicine (CAM) has mainly focused on CAM utilisation by patients. Fewer studies have analysed extent and structure of CAM provision or the reasons why physicians offer CAM as a therapeutic option in the outpatient setting. METHODS: A standardised questionnaire was developed addressing reasons and patterns of CAM provision. The questionnaire was sent by post to 2,396 general practitioners and specialists in 9 selected German districts. 553 physicians participated in the survey (23%). RESULTS: 63% of the respondents (n=350) answered that they had provided some sort of CAM to their patients within a period of 12 months preceding the study. The most frequently provided methods were acupuncture/traditional Chinese medicine, herbal remedies and homeopathy. In the sample, 90% of the orthopaedists were CAM providers, the highest rate among the participating disciplines. Several reasons for offering CAM were identified: conviction of therapeutic effectiveness regarding the patient's situation (68%), aspects of therapeutic freedom (47%) or less harmful side effects than conventional therapies (34%). 6% provide CAM for monetary reasons. CONCLUSION: Findings suggest that the provision of CAM is widespread in the German outpatient setting. However, it has to be taken into account that a selection bias may apply which may lead to an overestimation of CAM provision. Doctors' reasons to offer CAM are manifold; therapeutic reasons seem to outweigh economic motives.

Physicians' knowledge, attitudes, and practices regarding fibromyalgia: A systematic review and meta-analysis of cross-sectional studies.

BACKGROUND: The diagnosis, etiology, and optimal management of fibromyalgia remains contentious. This uncertainty may result in variability in clinical management. We conducted a systematic review and meta-analysis of cross-sectional studies examining physicians' knowledge, attitudes, and practices regarding fibromyalgia. METHODS: We searched MEDLINE, Embase, and PubMed from inception to February 2023 for cross-sectional surveys evaluating physicians' attitudes toward, and management of, fibromyalgia. Pairs of independent reviewers conducted article screening, data extraction, and risk of bias assessment in duplicate. We used random-effects meta-analysis to pool proportions for items reported by more than one study and the Grading of Recommendations Assessment, Development, and Evaluation approach to summarize the certainty of evidence. RESULTS: Of 864 citations, 21 studies (8904 participants) were eligible for review. Most physicians endorsed fibromyalgia as a distinct clinical entity (84%; 95% confidence interval [CI], 74-92), and half (51%; 95% CI, 40-62) considered fibromyalgia a psychosocial condition. Knowledge of formal diagnostic criteria for fibromyalgia was more likely among rheumatologists (69%, 95% CI, 45-89) versus general practitioners (38%, 95% CI, 24-54) (P = .04). Symptom relief was endorsed as the primary management goal by most physicians (73%, 95% CI, 52-90). Exercise, physiotherapy, antidepressants, nonsteroidal anti-inflammatory drugs, and non-opioid analgesics were most endorsed for management of fibromyalgia, but with wide variability between surveys. Opioids and most complementary and alternative interventions (e.g., homeopathy, chiropractic, and massage) received limited endorsement. CONCLUSION: There is moderate certainty evidence to suggest that physicians are divided regarding whether fibromyalgia is a biomedical or psychosocial disorder. Physicians typically prioritize symptom relief as the primary goal of management, and often endorse management with exercise, non-opioid analgesics, nonsteroidal anti-inflammatory drugs, antidepressants, and physiotherapy (moderate to high certainty evidence); however, important practice variation exists.

Homeopathic prescribing for chronic and acute periodontal conditions in 3 dental practices in the UK.

INTRODUCTION: This investigation extends our previous dental data collection pilot study with the following main aims: to gain insight into the periodontal complaints that dentists in the UK treat using individualised homeopathic prescription; to record patient-assessed change in severity of treated complaint (acute or chronic); to determine periodontal pocket depth (PPD). MATERIALS AND METHODS: Three dentists recorded data systematically at 249 homeopathic appointments in 51 patients over a period of 18 months. A spreadsheet enabled the data collection of the following records: date of appointment; anonymised patient identity; main periodontal problem treated; whether the condition was acute or chronic; patient-assessed clinical outcome on a 7-point Likert scale, ranging from -3 to +3, to compare the first and any subsequent appointments; whether any interventional dental surgery (IDS) had been carried out; clinician-assessed PPD measurements. RESULTS: At least one follow-up (FU) appointment was reported for each of 46 patients (22 chronic [6 with IDS, 16 without IDS]; 24 acute [10 with IDS, 14 without IDS]). In chronic cases, strongly positive outcomes (score of +2 or +3) were reported by 2 (33.3%) of 6 IDS patients and by 1 (6.3%) of 16 non-IDS patients. In acute cases, strongly positive outcomes were reported by 7 (70%) of 10 IDS patients and by 8 (57.2%) of 14 non-IDS patients (no statistically significant difference between sub-groups). The FU conditions most frequently treated with homeopathy were chronic periodontitis (19 patients) and acute periodontal abscess (11 patients). Analysis of PPD data was not feasible due to the small numbers of patients involved. CONCLUSION: Limited insight has been gained into the periodontal complaints treated by homeopathy in the UK. Due to small sample size and equivocal results, the interpretation of the patient-reported outcomes data is unclear. Positive findings obtained in the acute treatment setting suggest that this may be a promising area for research in periodontal homeopathy.

Prevalence of use of complementary and alternative medicine (CAM) by physicians in the UK: a systematic review of surveys.

This systematic review aims to estimate the prevalence of use of complementary and alternative medicine (CAM) by physicians in the UK. Five databases were searched for surveys monitoring the prevalence of use of CAM, which were published between 1 January 1995 and 7 December 2011. In total, 14 papers that reported 13 separate surveys met our inclusion criteria. Most were of poor methodological quality. The average prevalence of use of CAM across all surveys was 20.6% (range 12.1-32%). The average referral rate to CAM was 39% (range 24.6-86%), and CAM was recommended by 46% of physicians (range 38-55%). The average percentage of physicians who had received training in CAM was 10.3% (range 4.8-21%). The three most commonly used methods of CAM were acupuncture, homeopathy and relaxation therapy. A sizable proportion of physicians in the UK seem to employ some type of CAM, yet many have not received any training in CAM. This raises issues related to medical ethics, professional competence and education of physicians.

Homeopathic prescribing for chronic conditions in feline and canine veterinary practice.

INTRODUCTION: The peer-review literature contains no controlled clinical research of homeopathy in cats and very little in dogs. MAIN OBJECTIVE: To collect clinical outcomes data systematically from individualised homeopathic treatment of cats and dogs that would help to inform controlled research in feline and canine homeopathy. METHODS: Twenty-one homeopathic veterinary surgeons recorded data systematically from consecutive feline and canine patients over a 12-month period. Records included: date; patient and owner identity (anonymised); medical problem treated; whether new or follow-up (FU) appointment; chronic or acute condition; owner-assessed clinical outcome (7-point scale, range -3 to +3) compared with first appointment. RESULTS: Data from 400 cats comprised a total of 372 individual chronic problems, of which 270 had FU assessment. Data from 1504 dogs comprised a total of 1408 individual chronic problems, of which 1070 had FU assessment. In both species, 22% of FUs in chronic cases received conventional medicines concurrently. In cats, 117 different chronic medical conditions in total were treated with homeopathy. Five of those conditions included ≥20 cases, in which owner-reported outcomes (in decreasing rank order of frequency) were: dermatitis (69.6% patients with +2 or +3 outcome, 0% patients with -2 or -3 outcome); renal failure (57.1%, 14.3%); overgrooming (57.1%, 7.2%); arthritis (80.0%, 0%); hyperthyroidism (66.7%, 0%). In dogs, of 301 different chronic medical conditions treated in total, those most commonly recorded (≥20 cases) were: dermatitis (66.2% with +2 or +3 outcome, 5.4% with -2 or -3 outcome); arthritis (80.2%, 0.8%); pyoderma (75.8%, 0%); colitis (85.2%, 0%); fear (31.6%, 0%); epilepsy (63.6%, 4.5%); otitis externa (72.7%, 0%); diarrhoea (68.2%, 0%); urinary incontinence (73.7%, 0%); aggression (57.1%, 0%); spondylosis (81.0%, 0%); lymphoma (40.0%, 6.7%). CONCLUSIONS: A programme of controlled research in veterinary homeopathy for these feline and canine conditions is clearly indicated.

The use of Complementary and Alternative Medicine (CAM) among Italian children: A cross-sectional survey.

OBJECTIVE: To examine prevalence and modalities of CAM use in children living in Novara, a northern Italian city, and to estimate the prescription rate from paediatricians. METHOD: We administered a phone questionnaire to the parents of a sample of 147 children, asking questions about CAM use, children's health profile, parental socio-economic status, use modalities, effectiveness perceptions, and motivations. A parallel survey was conducted by e-mail by investigating family paediatricians attitudes about CAM. RESULTS: Among 147 children whose families responded to our survey 48.3% was treated with CAM at least once in life and 38,1% during the previous year. Children treated with CAM were on average younger than those who were not. The types of CAM used were herbal medicine and homeopathy. Parents who choose CAM for their children were more skeptical about vaccinations. CAM were most frequently used to treat pathologies of ear, nose and throat. 85.9% of parents was willing to use CAM in future, 78.9% would pass to conventional medicine if CAM failed. Among paediatricians 81.5% prescribed CAM at least once, but only 13.6% received specific CAM training. CONCLUSION: The prevalence of children using CAM in Novara is high, in line with investigations conducted in Northern European countries. The distribution of pathologies treated with CAM, parental socio-economic status and general scepticism towards vaccination are consistent with the literature. Physicians should keep themselves up-to-date also about evidence-based CAM therapies and, most importantly, should have an open dialogue about CAM with their patients.

Patient satisfaction and side effects in primary care: an observational study comparing homeopathy and conventional medicine.

BACKGROUND: This study is part of a nationwide evaluation of complementary medicine in Switzerland (Programme Evaluation of Complementary Medicine PEK) and was funded by the Swiss Federal Office of Public Health. The main objective of this study is to investigate patient satisfaction and perception of side effects in homeopathy compared with conventional care in a primary care setting. METHODS: We examined data from two cross-sectional studies conducted in 2002-2003. The first study was a physician questionnaire assessing structural characteristics of practices. The second study was conducted on four given days during a 12-month period in 2002/2003 using a physician and patient questionnaire at consultation and a patient questionnaire mailed to the patient one month later (including Europep questionnaire).The participating physicians were all trained and licensed in conventional medicine. An additional qualification was required for medical doctors providing homeopathy (membership in the Swiss association of homeopathic physicians SVHA). RESULTS: A total of 6778 adult patients received the questionnaire and 3126 responded (46.1%). Statistically significant differences were found with respect to health status (higher percentage of chronic and severe conditions in the homeopathic group), perception of side effects (higher percentage of reported side effects in the conventional group) and patient satisfaction (higher percentage of satisfied patients in the homeopathic group). CONCLUSION: Overall patient satisfaction was significantly higher in homeopathic than in conventional care. Homeopathic treatments were perceived as a low-risk therapy with two to three times fewer side effects than conventional care.

Why pediatric health care providers are not using homeopathic antidiarrheal agents.

OBJECTIVES: Several randomized, controlled trials have demonstrated the efficacy of homeopathic agents for use in childhood diarrhea. However, this therapeutic innovation is not being routinely adopted. We chose to study the degree of adoption as well as the perceived reasons for failure to adopt homeopathic antidiarrheal agents by pediatric health care providers. Additionally, we sought to determine if these agents are likely to be adopted in the future. DESIGN: This study was a self-administered survey, including a standardized scale of innovativeness. SUBJECTS: Subjects for this study were pediatric health care providers, and interventions consisted of abstracted results of two randomized, controlled, double-blinded studies reporting on the efficacy of homeopathic antidiarrheal agents. OUTCOME MEASURES: Outcome measures consisted of reports of the current treatment approach to childhood diarrhea, innovativeness, perceptions homeopathic antidiarrheal agent efficacy, and barriers to use, before and after reading the abstracts. RESULTS: We obtained a 61% response rate. Only 3% of surveyed respondents use homeopathic antidiarrheal agents. Lack of experiential knowledge, awareness, concerns of effectiveness, and safety were the greatest barriers to adoption. More respondents felt that homeopathic antidiarrheal agents were efficacious after reading supportive abstracts, but this did not increase their willingness to use these agents. Adoption did not correlate with individual innovativeness. CONCLUSIONS: The use of homeopathic antidiarrheal agents for childhood diarrhea is a minimally adopted innovation. Lack of correlation between adoption and individual innovativeness may suggest that this innovation is unlikely to be adopted in the future without intervention. Current barriers to adoption reveal that a stronger evidence base, and efforts to increase awareness and experiential knowledge, would be necessary to increase adoption. The results reported in this paper are discussed in the context of current theories on knowledge translation in medicine.

French family physician experience concerning the outpatient care for women suffering from nausea and vomiting in pregnancy.

OBJECTIVE: To explore thoughts and attitudes among French family physicians on the outpatient care for women suffering from nausea and vomiting in pregnancy (NVP). DESIGN AND SETTING: A retrospective study was conducted among family physicians who had taken care of pregnant women who gave birth in our hospital in 1 year. PATIENTS AND METHODS: Fifty-nine French family physicians responded to a questionnaire assessing their experience about outpatient care for women suffering from NVP. Analysis were done according to the physicians' age, as the annual demographics data analysis from the French Medical Council. RESULTS: More than 89% of family physicians asked systematically the question concerning NVP (53/59), which were estimated as a frequent symptom (n=44, 74.6%). The intensity of NVP was assessed as mild in 28.8% (n=17), moderate in 62.7% (n=37), severe in 6.8% (n=4) and unbearable in 1.7% (n=1). Physicians younger than 40 years questionned less frequently about NVP compared to those older than 40 or older than 60 years (66.7% vs. 90.5% vs. 95.5%, respectively; P=0.04). Severe and unbearable NVP were significantly estimated more frequent among younger physicians (33.3% vs. 6.8%; P=0.03). Treatments (sick leave, diet, drugs, homeopathy, acupuncture or psychotherapy) did not differ between groups. DISCUSSION AND CONCLUSION: Outpatient care for women suffering from NVP may vary according to the physician. French family physicians played a key role in NVP. Younger family physician considered NVP as a frequent symptom which needed active management in severe forms.

Alternative medicine: an ethnographic study of how practitioners of Indian medical systems manage TB in Mumbai.

BACKGROUND: Mumbai is a hot spot for drug-resistant TB, and private practitioners trained in AYUSH systems (Ayurveda, yoga, Unani, Siddha and homeopathy) are major healthcare providers. It is important to understand how AYUSH practitioners manage patients with TB or presumptive TB. METHODS: We conducted semi-structured interviews of 175 Mumbai slum-based practitioners holding degrees in Ayurveda, homeopathy and Unani. Most providers gave multiple interviews. We observed 10 providers in clinical interactions, documenting: clinical examinations, symptoms, history taking, prescriptions and diagnostic tests. RESULTS: No practitioners exclusively used his or her system of training. The practice of biomedicine is frequent, with practitioners often using biomedical disease categories and diagnostics. The use of homeopathy was rare (only 4% of consultations with homeopaths resulted in homeopathic remedies) and Ayurveda rarer (3% of consultations). For TB, all mentioned chest x-ray while 31 (17.7%) mentioned sputum smear as a TB test. One hundred and sixty-four practitioners (93.7%) reported referring TB patients to a public hospital or chest physician. Eleven practitioners (6.3%) reported treating patients with TB. Nine (5.1%) reported treating patients with drug-susceptible TB with at least one second-line drug. CONCLUSIONS: Important sources of health care in Mumbai's slums, AYUSH physicians frequently use biomedical therapies and most refer patients with TB to chest physicians or the public sector. They are integral to TB care and control.

Integrative management of pediatric tonsillopharyngitis: An international survey.

This survey investigated the management of pediatric tonsillopharyngitis, with a focus on natural remedies. 138 pediatricians, general practitioners and ear-nose-throat (ENT) specialists in 7 countries were surveyed by a dedicated questionnaire. A rapid strept test (RST) to diagnose acute tonsillopharyngitis was routinely used by 56/138 participants (41%). The use of RST allowed 200 diagnosis/year compared with 125 diagnosis/year for clinicians who did not use this tool. Homeopathy remedies were prescribed as a supportive therapy by 62% of participants (85/138). Among different homeopathic remedies, SilAtro-5-90 was the most frequently prescribed (53/138, 38%). In the chronic setting, homeopathy was suggested as a supportive therapy by 82/138 participants (59%), phytotherapy by 39 (28%) and vitamins/nutritional supplementation by 51 (37%). The management of tonsillopharyngitis in pediatric patients still remains empiric. Natural remedies, and homeopathy in particular, are used in the management of URTIs. An integrative approach to these infections may help reduce excessive antibiotic prescription.

Psychopharmacological Prescriptions in Children and Adolescents in Germany.

BACKGROUND: In view of the well-known increase in prescriptions of stimulants for children and adolescents over the last 20 years, it is important to study trends in the prevalence and incidence of the use of other psychotropic drugs by this age group as well, to enable an early response to potential problems in the current care situation. METHODS: We used nationwide data from German statutory health insurance funds (Allgemeine Ortskrankenkasse [AOK], all insurees; Techniker Kranken - kasse [TK], a 50% randomized sample) concerning all insurees aged 0-17 years (5.0 million people in 2012) to study trends in the prevalence and incidence of psychotropic medication use as well as initially prescribing medical specialties over the period 2004-2012, both for the overall group of psychotropic drugs and for selected subgroups of drugs. RESULTS: From 2004 to 2012, the prevalence of psychotropic drug prescriptions (not including herbal and homeopathic substances) for children and adolescents rose from 19.6 to 27.1 per 1000 individuals. Marked rises were seen for stimulants (10.5 to 19.1 per 1000) and antipsychotic drugs (2.3 to 3.1 per 1000), while the prevalence of antidepressant prescriptions remained constant at about 2 per 1000. The rates of new prescriptions from 2006 to 2012 were generally constant or decreasing; for the overall group of (non-herbal, nonhomeopathic) psychotropic drugs, the rate of new prescriptions fell from 9.9 to 8.7 per 1000. There was a trend toward the issuance of new prescriptions by medical specialists, rather than by family physicians and pediatricians. CONCLUSION: The observed increased prevalence of psychotropic drug use among children and adolescents appears to be due not to an increased rate of initial prescriptions for these drugs, but rather to a rise in the number of patients who, once having received such drugs, were given further prescriptions for them in the years that followed.

Safety of homeopathic injectables for subcutaneous administration: a documentation of the experience of prescribing practitioners.

OBJECTIVES: The aim of this study was to chart the experiences of homeopathic injectables prescribing practitioners with regard to safety issues and the extent in which these practitioners would feel restricted in case subcutaneously administered homeopathics were banned. DESIGN: This was a survey among practitioners who prescribe homeopathic injectables in 12 European countries. SUBJECTS: Data were gathered from 1693 doctors experienced in the use of homeopathic injectables for subcutaneous use. The data are based on experience with an estimated 36 million patient contacts. RESULTS: Of the 1693 doctors 1594 (94.2%) choose subcutaneous administration because of its therapeutic effect. 96.4% of the doctors never, very rarely, or rarely, observed any adverse reactions because of the subcutaneous form of application. The reported adverse reactions were mostly harmless (local redness, hematoma, local pain). Of the doctors, 98.1% never, very rarely, or rarely observed any adverse reactions caused by the specific homeopathic medicinal product used. In addition, 99.5% of the doctors desire homeopathic injectables for subcutaneous use to stay on the market and 89% would be severely or very severely limited in their profession if homeopathic injectables were not available. CONCLUSIONS: The study suggests that homeopathic injectables have a very low risk profile. A very small number of severe adverse reactions (anaphylactic reaction, feverish symptoms, aversion/anxiety against injections, and asthma) have been reported with products with a concentration higher than 1:10,000.

The integration of complementary therapies in Australian general practice: results of a national survey.

METHODS: Australian general practitioners' (GPs) attitudes toward and use of a range of complementary therapies (CTs) were determined through a self-administered postal survey sent to a random sample of 2000 Australian GPs. The survey canvassed GPs' opinions as to the harmfulness and effectiveness of CTs; current levels of training and interest in further training; personal use of, and use in practice of, CTs; referrals to CT; practitioners; appropriateness for GPs to practice and for government regulation; perceived patient demand and the need for undergraduate education. RESULTS: The response rate was 33.2%. Based on GPs' responses, complementary therapies could be classified into: nonmedicinal and nonmanipulative therapies, such as acupuncture, massage, meditation, yoga, and hypnosis, that were seen to be highly effective and safe; medicinal and manipulative therapies, including chiropractic, Chinese herbal medicine, osteopathy, herbal medicine, vitamin and mineral therapy, naturopathy, and homeopathy, which more GPs considered potentially harmful than potentially effective; and esoteric therapies, such as spiritual healing, aromatherapy, and reflexology, which were seen to be relatively safe yet also relatively ineffective. The risks of CTs were seen to mainly arise from incorrect, inadequate, or delayed diagnoses and interactions between complementary medications and pharmaceuticals, rather than the specific risks of the therapies themselves. CONCLUSIONS: Nonmedicinal therapies along with chiropractic are widely accepted in Australia and can be considered mainstream. GPs are open to training in complementary therapies, and better communication between patients and GPs about use of CTs is required to minimize the risk of adverse events. There is also a need to prioritize and provide funding for further research into the potential adverse events from these therapies and other therapies currently lacking an evidence base.

Homeopathy and naturopathy: practice characteristics and pediatric care.

OBJECTIVE: To describe the practice characteristics and pediatric care of homeopathic practitioners (HPs) and naturopathic doctors (NDs). DESIGN: Cross-sectional, descriptive survey. SETTING: Homeopathic and naturopathic practices in Massachusetts. PARTICIPANTS: Homeopathic practitioners (N = 42) and NDs (N = 23) identified from the yellow pages, regional and national society membership lists, schools, magazine advertisements, and by word-of-mouth. The response rate was 55% (23/42) for HPs and 65% (15/23) for NDs. MAIN OUTCOME MEASURES: Demographics, practice characteristics, fee structure, and amount of pediatric care. Practitioners were asked for their approach to childhood immunizations and to treating a febrile neonate. Data were analyzed using simple descriptive statistics. RESULTS: Almost all respondents were white. Among the HPs, 13 (57%) were licensed medical doctors. Naturopathic doctors and HPs reported having an average of only 25 to 40 patient visits per week, but children and adolescents accounted for up to one third of these visits. Nearly all reported treating children, but fewer than half of the practitioners reported any formal pediatric training. Initial patient visits typically lasted more than 1 hour and cost $140 to $150. Follow-up visits were scheduled every 4 to 6 weeks and lasted more than 30 minutes on average. Insurance covered less than one third of the patient visits, and sliding scale payments were offered by less than half of the respondents. Most practitioners reported that they did not actively recommend immunizations and fewer than half of the nonphysician practitioners reported that they would refer a 2-week-old neonate with a fever to a medical doctor or emergency medical facility. CONCLUSIONS: Many patients using homeopathy and naturopathy are children. Visits to these providers are frequent and fees are primarily paid out-of-pocket. Failure on the part of these providers to recommend immunizations or recognize potentially serious illnesses is cause for concern.

[Lack of conviction about vaccination in certain Quebec vaccinators]. / Manque de conviction face à la vaccination chez certains vaccinateurs québécois.

A questionnaire was mailed to all vaccinators in Quebec in 1998. The objective of this survey was to document vaccinators' attitudes, knowledge, and practices related to vaccination. Vaccinators generally believe in the security, efficacy and usefulness of vaccines given to young children. However, 41% of nurses do not fully agree with these opinions. More than 94% of pediatricians completely disagree that "certain practices (homeopathy, good eating habits and a healthy lifestyle) can eliminate the need for vaccination", compared with 85% of general practitioners and only 60% of nurses. Less than 25% of doctors recall children who are late in getting their immunizations; approximately 45% of vaccinators are in complete agreement with simultaneous injections of two vaccines; many circumstances are incorrectly seen as contra indications for vaccination. Public health authorities should target systematic interventions towards vaccinators to improve this situation and to increase nurses' conviction regarding the benefits of vaccination.

Practice patterns of naturopathic physicians: results from a random survey of licensed practitioners in two US States.

BACKGROUND: Despite the growing use of complementary and alternative medicine (CAM) by consumers in the U.S., little is known about the practice of CAM providers. The objective of this study was to describe and compare the practice patterns of naturopathic physicians in Washington State and Connecticut. METHODS: Telephone interviews were conducted with state-wide random samples of licensed naturopathic physicians and data were collected on consecutive patient visits in 1998 and 1999. The main outcome measures were: Sociodemographic, training and practice characteristics of naturopathic physicians; and demographics, reasons for visit, types of treatments, payment source and visit duration for patients. RESULT: One hundred and seventy practitioners were interviewed and 99 recorded data on a total of 1817 patient visits. Naturopathic physicians in Washington and Connecticut had similar demographic and practice characteristics. Both the practitioners and their patients were primarily White and female. Almost 75% of all naturopathic visits were for chronic complaints, most frequently fatigue, headache, and back symptoms. Complete blood counts, serum chemistries, lipids panels and stool analyses were ordered for 4% to 10% of visits. All other diagnostic tests were ordered less frequently. The most commonly prescribed naturopathic therapeutics were: botanical medicines (51% of visits in Connecticut, 43% in Washington), vitamins (41% and 43%), minerals (35% and 39%), homeopathy (29% and 19%) and allergy treatments (11% and 13%). The mean visit length was about 40 minutes. Approximately half the visits were paid directly by the patient. CONCLUSION: This study provides information that will help other health care providers, patients and policy makers better understand the nature of naturopathic care.

Spirituality and choice of health care practitioner.

BACKGROUND: Patients who include a complementary and alternative medicine (CAM) practitioner in their health care represent a small percentage of the population identified as CAM users. Their choice may be motivated by intangible personality or worldview characteristics. OBJECTIVE: A prospective study was designed to determine if a patient's choice of conventional or alternative health care practitioner was related to total score on an instrument for scaling psychospiritual characteristics. DESIGN: A sequential convenience sample of patients attending five different health care practices in New England. SETTING: A family practitioner (FP) who uses CAM. (1) A FP clearly not identified with CAM. (3) A chiropractor. (4) A naturopath, and (5) A homeopath. OUTCOME MEASURES: Total scores on the Spiritual Involvement and Beliefs Scale (SIBS), plus item scores of five separate questions and two factors. RESULTS: With 210 respondents, SIBS scores in Practice 2 were significantly lower than in practice 1 (p = 0.004), 3 (p = 0.001), 4 (p = 0.018), and 5 (p = 0.02). This pattern remained over the five question scores and two factors. CONCLUSION: Patients who chose a physician associated with CAM, or an alternative practitioner (chiropractor, naturopath, or homeopath) for their direct health care scored higher on a psychospiritual testing instrument (SIBS) than those who chose a conventional physician.