Common Factor Mechanisms in Clinical Practice and Their Relationship with Outcome.

UNLABELLED: This study investigates three common factor mechanisms that could affect outcome in clinical practice: response expectancy, the affective expectation model and motivational concordance. Clients attending a gestalt therapy clinic (30 clients), a sophrology (therapeutic technique) clinic (33 clients) and a homeopathy clinic (31 clients) completed measures of expectancy and the Positive Affect and Negative Affect Schedule (PANAS) before their first session. After 1 month, they completed PANAS and measures of intrinsic motivation, perceived effort and empowerment. Expectancy was not associated with better outcome and was no different between treatments. Although some of the 54 clients who endorsed highest expectations showed substantial improvement, others did not: 19 had no change or deteriorated in positive affect, and 18 had the same result for negative affect. Intrinsic motivation independently predicted changes in negative affect (ß = -0.23). Intrinsic motivation (ß = 0.24), effort (ß = 0.23) and empowerment (ß = 0.20) independently predicted positive affect change. Expectancy (ß = -0.17) negatively affected changes in positive affect. Clients found gestalt and sophrology to be more intrinsically motivating, empowering and effortful compared with homeopathy. Greater improvement in mood was found for sophrology and gestalt than for homeopathy clients. These findings are inconsistent with response expectancy as a common factor mechanism in clinical practice. The results support motivational concordance (outcome influenced by the intrinsic enjoyment of the therapy) and the affective expectation model (high expectations can lead for some clients to worse outcome). When expectancy correlates with outcome in some other studies, this may be due to confound between expectancy and intrinsic enjoyment. KEY PRACTITIONER MESSAGE: Common factors play an important role in outcome. Intrinsic enjoyment of a therapeutic treatment is associated with better outcome. Active engagement with a therapeutic treatment improves outcome. Unrealistic expectations about a therapeutic treatment can have a negative impact on outcome.

Use of natural health products in children: survey of parents in waiting rooms.

OBJECTIVE: To determine how common it is for parents to give natural health products (NHPs) to their children, which NHPs are being used, why they are being used, and parents' assessments of the benefits and side effects of NHPs. DESIGN: Survey. SETTING: Newfoundland and Labrador. PARTICIPANTS: Parents waiting in their family doctors' offices. MAIN OUTCOME MEASURES: Parent and child demographic characteristics; pediatric chronic medical conditions affecting the children; prescribed medications, over-the-counter medications, and NHPs used by the children; why the medications and NHPs were being used, the dose, and parents' assessments of the effectiveness and side effects; and where parents had heard about the NHPs, whether they had told their physicians that the children were taking the products, and where they had obtained the products. RESULTS: A total of 202 (53.4%) of the 378 eligible adults who were approached completed the survey. This represented 333 children. Mean (SD) age of the children was 5.1 (3.3) years. Overall, 28.7% of parents reported using nonvitamin NHPs for their children. A total of 137 children (41.1%) had taken NHPs (including vitamins); 61.1% of the NHPs being used were vitamins. The remainder fell under teas (primarily chamomile and green teas), echinacea, fish or omega-3 oils, and a large category of "other" products. These NHPs were most commonly used to improve general health, improve immunity, and prevent colds and infections. Approximately half of the parents (51.7%) believed their children had benefited from taking NHPs, and 4.4% believed their children had experienced adverse side effects. Slightly less than half of the parents (45.0%) had informed their physicians that their children were taking NHPs. CONCLUSION: Overall, 45.5% of parents attending physicians' offices reported using NHPs in their children. If vitamins are not included in the definition of NHPs, this rate drops to 28.7%. Parents most commonly use NHPs to maintain the general health of their children, to prevent colds, and to boost children's immune systems. About half of the parents believed the NHPs helped, very few had noticed any side effects, and approximately half had informed their physicians that they were giving their children NHPs.

Naturopathic Oncology Care for Pediatric Cancers: A Practice Survey.

Background: The majority of pediatric oncology patients report use of complementary and alternative medicine. Some naturopathic doctors (NDs) provide supportive pediatric oncology care; however, little information exists to formally describe this clinical practice. A survey was conducted with members of the Oncology Association of Naturopathic Physicians (OncANP.org) to describe recommendations across four therapeutic domains: natural health products (NHPs), nutrition, physical medicine, and mental/emotional support. Results: We had 99 respondents with a wide variance of clinical experience and aptitude to treat children with cancer. Of the majority (52.5%) of respondents who choose not to treat these children, the three primary reasons for this are lack of public demand (45.1%), institutional or clinic restrictions (21.6%), and personal reasons/comfort (19.6%). The 10 most frequently considered NHPs by all NDs are fish-derived omega-3 fatty acid (83.3%), vitamin D (83.3%), probiotics (82.1%), melatonin (73.8%), vitamin C (72.6%), homeopathic Arnica (69.0%), turmeric/curcumin (67.9%), glutamine (66.7%), Astragalus membranaceus (64.3%), and Coriolus versicolor/PSK (polysaccharide K) extracts (61.9%). The top 5 nutritional recommendations are anti-inflammatory diets (77.9%), dairy restriction (66.2%), Mediterranean diet (66.2%), gluten restriction (61.8%), and ketogenic diet (57.4%). The top 5 physical modality interventions are exercise (94.1%), acupuncture (77.9%), acupressure (72.1%), craniosacral therapy (69.1%), and yoga (69.1%). The top 5 mental/emotional interventions are meditation (79.4%), art therapy (77.9%), mindfulness-based stress reduction (70.6%), music therapy (70.6%), and visualization therapy (67.6%). Conclusion: The results of our clinical practice survey highlight naturopathic interventions across four domains with a strong rationale for further inquiry in the care of children with cancer.

[Homeopathic drug products and outpatient clinics: are they deceiving the public?] / I prodotti e gli ambulatori omeopatici non ingannano il pubblico?

After more than two centuries since the inception of homeopathy, it can now be stated that active ingredients of homeopathic drug products are approaching zero. Homeopathy has never been shown to be effective, and several Cochrane reviews failed to provide evidence for the effectiveness of homeopathy. In addition, according to the World Health Organization, when homeopathic medicine is used as an alternative to other effective treatments, it may cause harm resulting in increased mortality. On the basis of these considerations, it is of utmost importance that millions of Italian people taking homeopathic remedies be informed on the negative judgment by the scientific community, so that allocation of limited healthcare resources can be better redirected to increase patient access to treatments not otherwise available due to restrictions on healthcare budgets (e.g. hepatitis C medications).

Homeopathy service in a National Health Service community menopause clinic: audit of clinical outcomes.

Sheffield's National Health Service community menopause clinic has run a homeopathy service since 1998. The service provides an alternative treatment option for those women who cannot take hormone replacement therapy, do not want it, have found it ineffective, or have been advised to stop it. Patients receive homeopathic treatment (monthly consultations plus individualized homeopathic medicines) for up to six sessions. An audit was undertaken of all patients referred to this service between 2001 and 2003, in which patients completed the Measure Yourself Medical Outcome Profile. Patients reported significant benefit from the service. The greatest response was seen in those reporting headaches, vasomotor symptoms, emotional/psychological symptoms and tiredness/fatigue as their primary symptoms.

Characteristics of patients at a complementary medicine clinic in Beer Sheva: summary of the first two years of operation.

BACKGROUND: "Complementary medicine" incorporates several methods of treatment, all of which aim to promote the health and quality of life of the patient. Public interest and demand for complementary medicine services have increased in recent years in Israel, as they have throughout the western world. OBJECTIVE: To characterize patients attending the Complementary Medicine Clinic in southern Israel at the completion of its first 2 years of operation. METHODS: Data for 398 patients selected at random from 4,400 patients treated in the clinic were collected retroactively from the patients' charts. RESULTS: Of those who visited the clinic, 68% were women with an average age of 49 years. Patients attending the clinic had higher rates of hypertension (20%), diabetes (6%) and heart disease (7%) than the general population of patients insured at the Clalit Health Services in the southern region. In addition to musculoskeletal problems (47%), the other most common complaint was emotional problems (13%) such as tension and anxiety. Acupuncture and Shiatsu were the most commonly used types of treatment (61%). Homeopathy was used by 7%. Among patients with musculoskeletal problems, there were significantly more men than women (P = 0.02), the mean age was higher (P = 0.07), and more of them were referred by friends or family (P = 0.06) than those with other problems. CONCLUSIONS: Characterizing patients attending a complementary medicine clinic is important for the planning of marketing and resource management, and can assist primary care physicians in decisions regarding the referral of patients to this type of healthcare.

A positive concept of health - interviews with patients and practitioners in an integrative medicine clinic.

Using the phenomenography method, interviews with patients and practitioners were undertaken to explore their understanding of 'health that is more than the absence of disease'. The question was challenging and stimulating for all interviewees. A few were unable to conceptualise this positive definition of health, some perceived it as an optimum end-state, whereas others saw it as an ongoing process. Many positive attributes of health and its influencers were identified. The more advanced understandings of this concept were of a holistic, multidimensional, expansive state where the all dimensions of health are interdependent and positively reinforcing. The results affirmed that wellness is more than psychological wellbeing, 'happiness' and life satisfaction. Optimum physical and cognitive capacities along with spiritual, social and occupational wellness were equally as important. 'Energy and vitality' were sufficiently emphasised by patients and some practitioners to support the inclusion of the principles of vitalism in any discussion about health.

Complementary and alternative medicine in paediatrics in daily practice--a European perspective.

INTRODUCTION: Complementary and alternative medicine (CAM) is used by both adults and children in Europe. Diverse cultural, ethnic and historical preconditions in European countries result in broad differences between the types of CAM practiced, prevalence of CAM use and integration in the health system. To date, no survey of CAM availability to paediatric patients in Europe exists. METHODS: We present an overview of CAM integration within the different levels of the European paediatric health systems as a narrative review. Paediatric CAM specialists in 20 European countries provided information about CAM integration in their countries in semi-structured interviews. RESULTS: Data from 20 European countries were available, representing 68% of the European population. CAM is offered in private practices in all 20 (100%) countries, and 80% described some form of CAM training for health professionals. While CAM is offered in outpatient clinics treating adults in 80% of these countries, only 35% offer CAM in paediatric outpatient clinics. Dedicated CAM inpatient wards exist in 65% of the countries for adults, but only in Germany and the Netherlands for children. Groups conducting some CAM research or CAM research focussed on paediatrics exist in 65% and 50% of the 20 countries, respectively. Homeopathy, acupuncture and anthroposophic medicine were most often named. CONCLUSION: Every child in Europe has access to CAM treatment, mainly in private practices, whereas CAM outpatient clinics and inpatient services for children are rare. This is in contrast to adult treatment facilities, many of which offer CAM services, and the high percentage of European children using CAM.

Perfil Clínico Epidemiológico do Ambulatório de Homeopatia do Hospital Universitário da UNIRIO, Brasil / Clinical homeopathic study in the homeopathic ambulatory at UNIRIO University Hospital, Brazil

Background: In 1966, the Gaffrée and Guinle University Hospital ? GGUH was incorporated into the Federal University of the State of Rio de Janeiro ? UNIRIO. Since then the Homeopathy clinic has had it's service there. Since the creation of medical residency in Homeopathy in 2004, there has been a significant increase of treatment in the number of patients and also a significant increase in the inter-relationship with other specialists and hospital services. A wide variety of patients have been treated at the GGUH on a daily basis. Many patients have been examined and treated with homeopathy alone, while others were also examined in other specialties, making homeopathic treatment an adjunct to classical therapy and vice versa. Given the expressive number of medical consultations (around 2500/year), this outstanding result in our clinical and academic practice has created the relevance and need for the verification of the epidemiological profile of these patients. Epidemiological studies are needed to clearly show the population included in this hospital, which is considered to be a reference in the Brazilian Health System (SUS). Aims: To demonstrate the epidemiological and clinical homeopathic profile in the ambulatory of homeopathy at the Gaffrée and Guinle University Hospital (GGUH) of the Federal University of the Staate of Rio de Janeiro - UNIRIO, Brazil. Methodology: Cross-sectional study of 140 medical records randomly selected from the ambulatory of homeopathy at GGUH. The sample represents 50% of the monthly average of the clinical service from January to October 2009. The medical records incorrectly completed for the data analysis were excluded. Microsoft Office Excel 2007 used to data collection and analysis. Results and Discussion: A total of 100 records were selected for analysis (71.4%). Average age: 50 years old, 69% being between 41 and 80 years old. Gender: 79% women and 21% men. Marital status: 46% married, 36% single, 10% divorced and 8% widowed. Color: 61% white, 31% colored and 8% black. Education: Only 12% obtained an undergratuadion degree. Groups of diseases: Group-01 (48%) high prevalence: 19% respiratory, 15% osteoarticular and 14% psychiatric; Group-02 (45%) medium prevalence: 11% gastrointestinal, 9% cardiovascular, 8% genitourinary, 6% neurological, 6% dermatologic and 5% endocrine; Group-03 (7%) low prevalence: 3% otological, 2% immunological, 1% oncological and 1% ophtalmological. 82% of the patients were treated solely with homeopathy and 18% with homeopathy and allopathy. Clinical-homeopathic diagnosis: 53% functional, 38% lesional; 9% sensorial. Constitutional diagnoses: 31% sulfuric, 25% phosphoric, 22% carbonic, 22% mixed. Miasmatic / diathesic diagnosis: 47% sycotic, 28% psoric, 12.5% mixed, 9.5% tuberculinic, 3% syphilinic.Conclusion: This study demonstrated a higher prevalence of women over 50 years old with respiratory, osteoarticular and psychiatric diseases. Most of them had a sulfuric constitution and presented functional diseases of sycotic origin. Homeopathy was the most adopted treatment during the period studied. This knowledge led to the creation of the ?Homeopathic Clinical Identification Summary? which is used in theGGUH ambulatory. Epidemiological and clinical data were extracted from this summary with the objective to construct clinical trials.(AU)

Introdução: A clínica de Homeopatia do Hospital Universitário Gaffrée e Guinle? HUGG existe desde 1966, quando o hospital foi incorporado à Universidade Federal do Estado do Rio de Janeiro ? UNIRIO. Desde a criação da residência médica em Homeopatia em 2004, houve um aumento significativo no número de pacientes atendidos e na inter-relação com outros especialistas e serviços hospitalares. Dado o expressivo número de consultas médicas (cerca de 2500/ano), este excelente resultado em nossa prática clínica e acadêmica criou a relevância e necessidade para a verificação do perfil epidemiológico desses pacientes. Com a experiência de trabalho diário no HUGG, são observadas uma grande variedade de pacientes e doenças. Muitos pacientes são examinados e tratados pela homeopatia isoladamente, enquanto outros são vistos também em outras especialidades, fazendo tratamento homeopático como adjuvante à terapia clássica e vice-versa. Estudos epidemiológicos são necessários para mostrar claramente a população incluída neste hospital, que é considerado referência no Sistema Único de Saúde (SUS). Objetivos: Demonstrar o perfil epidemiológico e clínico homeopático do ambulatório de homeopatia do Hospital Universitário Gaffrée e Guinle (HUGG) da Universidade Federal do Rio de Janeiro Estado (UNIRIO), Brasil.Metodologia: Estudo transversal de 140 registros médicos selecionados aleatoriamente no ambulatório de homeopatia no HUGG. A amostra representa 50% da média mensal da assistência clínica, de janeiro aoutubro de 2009. Os prontuários preenchidos incorretamente para a análise dos dados foram excluídos. O programa Microsoft Office Excel 2007 foi utilizado para a coleta e análise de dados. Resultados e Discussão: Um total de 100 registros foram selecionados para análise (71,4%). Média de Idade: 50,18 anos de idade, sendo 69% entre 41 e 80 anos de idade. Sexo: as mulheres 79% homens e 21%. Estado civil: 46% casados, 36% solteiros, 10% divorciados e 8% viúvos. Cor: 61% branco, 31% pardos e 8% negros. Apenas 12% obtiveram escolaridade segundo grau completo. Observou-se pacientes com três grupos de patologias: Grupo-01 (48%) alta prevalência: 19% respiratórias, 15% osteoarticulares e 14% psiquiátricas; Grupo-02 (45%) média prevalência: 11% gastrointestinal, 9% cardiovascular, 8% geniturinário, 6% neurológicas, 6% dermatológicas e 5% endócrinas; Grupo-03 (7%) de baixa prevalência: 3% otológica, 2% imunológicos, 1% oncológico e 1% oftalmológicas. 82% dos pacientes foram tratados apenas com homeopatia e 18% com a homeopatia e alopatia. Diagnósticos Clínico-homeopáticos: 53% funcional, 38% lesional; 9% sensorial. Diagnósticos constitucionais: 31% sulfúrico, 25% fosfórico, 22% carbônico, 22% mistas. Diagnósticos Miasmáticos/diatésicos: 47% Sicóticos, 28%psóricos, 12,5% mistos, 9,5% tuberculínicos, 3% sifilinicos. Conclusão: Este estudo demonstrou uma maior prevalência de mulheres acima de 50 anos de idade e de doenças respiratórias, doenças osteoarticulares e psiquiátricas. A maioria dos pacientes com diagnóstico constitucional eram sulfúrico e apresentavam doenças funcionais de origem sicótica. A homeopatia foi o tratamento mais adotado durante o período estudado. Este conhecimento levou à criação do Ficha de Identificação Clínico-Homeopática, que é usado atualmente no ambulatório do HUGG, e, a partir deste trabalho, os dados epidemiológicos e clínicos poderão ser extraídos com mais objetividade e praticidade e permitirá a construção de ensaios clínicos específicos.(AU)

Making room for alternatives.

Alternative healing is an idea whose time has come, and 1993 was the critical year for that recognition. So believes internist David Edelberg, founder of the Chicago Holistic Center. There patients can see one of four allopathic physicians as well as practitioners in 37 additional therapies, including acupuncture, infant massage, homeopathy, nutrition counseling, and Ayurvedic medicine.

Abordagem terapeutica da asma bronquica no Servico de Homeopatia do Instituto de Assistencia aos Servicos do Estado do Rio de Janeiro (IASERJ) / Treatment of bronquic asmthma in the Homeopathic Service of the Instituto de Assistencia aos Servidores do Estado do Rio de Janeiro (IASERJ)

A asma bronquica que e caracterizada pela presenca de broncoespasmo, inflamacao da mucosa bronquica e hipersecrecao bronquica, decorrentes de hipersensibilidade e hiperatividade pulmonar a diversos fatores, foi estudada atraves do levantamento de fichas clinicas de 338 pacientes atendidos no periodo de 1997 a 1998, no Servico de Homeoparia do IASERJ. Os medicamentos mais frequentemente utilizados foram: Arsenicum album, Phosphorus, Pulsatilla, Natrum muriaticum e Lachesis. Os criterios de escolha foram: modalidades fisicas (sede, horario, respiracao, periodicidade, etc) e caracteristicas emocionais de cada paciente (medo, ansiedade, angustia, etc).(AU)