A constructivist grounded theory exploration of Mindfulness for Healthcare Professional students.

BACKGROUND AND PURPOSE: To better understand the effects of an intervention, Mindfulness for Healthcare Professional (MIHP), and how it may improve healthcare professional student (HCP) functioning, a constructivist grounded theory exploration was conducted. MATERIALS AND METHODS: Ten participants with the lowest or highest changes on quantitative measures of burnout and perceived stress at the end of MIHP were interviewed at a long-term follow-up. A theoretical framework was developed from the resultant themes to describe the mechanisms by which MIHP had effects on work-relevant functioning. RESULTS: Three overarching themes emerged as mechanisms of change both from their presence in those participants reporting an improvement in stress and their missingness from those participants who reported no change: developing a mindfulness practice, integrating practice into daily life, and enhanced awareness. These mechanisms led to optimized work-relevant functioning: 1) emotional competencies, including nonjudgement, emotion regulation, and burnout prevention; and 2) patient-centered care, including improved listening, patience, and efficiency at work. CONCLUSION: The resultant framework is discussed in the context of previous literature on MIHP and mindfulness theory more broadly. Implications for future disseminations of MIHP encourage the use of group interventions with emphasis on developing at-home practice and informal mindfulness integrated into daily work.

Relative popularity level of medicinal plants in Talagang, Punjab Province, Pakistan

ABSTRACT This is the first ethnobotanical exploration with the aim to document the traditional medicinal usage of plants with the therapeutic values in Tehsil Talagang of Punjab province, Pakistan. The study shows the dependence of local people on medicinal plants in their daily life and provides practical evidence regarding the traditional usage of medicinal plants in health care practices. A total of 196 respondents including residents of the study area with gender representation and traditional healers were interviewed by using visual appraisal approach and rapid rural appraisal methods along semi-structured interviews and open-ended questionnaire. The data was quantitatively analyzed by using quantitative indices like use value, the relative frequency of citation, informant consensus factor, fidelity level and relative importance. A comparison with 25 published ethnobotanical and pharmacological studies was carried out to authenticate the ethnomedicinal relevance of the data recorded. The ethnomedicinal practices of 101 medicinal plants belonging to 36 families were reported. The results indicated that the dominant family was Brassicaceae (nine species). Herbs (57%) were the most dominant life form and leaves (29%) were the frequently used plant part with 45 reports. Mentha arvensis was found as highly cited plant species by respondents. The highest informant consensus factor value (0.65) was found for gastrointestinal disease category. There are 25 plant species having 100% fidelity level value. Use value and relative frequency of citation ranges from 0.04 to 0.16 and 0.15 to 0.36, respectively. The majority of the plant species were found to have strong pharmacological evidence. The current study will provide the basis for the preservation of ethnomedicinal heritage, knowledge and practices as well as for the further scientific investigations regarding the development of new herbal drugs.

Data on medicinal plants used in Central America to manage diabetes and its sequelae (skin conditions, cardiovascular disease, kidney disease, urinary problems and vision loss).

The data described in this article is related to the review article "Medicinal plants used in the traditional management of diabetes and its sequelae in Central America: a review" (Giovannini et al., 2016) [1]. We searched publications on the useful plants of Central America in databases and journals by using selected relevant keywords. We then extracted reported uses of medicinal plants within the disease categories: diabetes mellitus, kidney disease, urinary problems, skin diseases and infections, cardiovascular disease, sexual dysfunction, vision loss, and nerve damage. The following countries were included in our definition of Central America: Belize, Guatemala, Honduras, El Salvador, Nicaragua, Costa Rica and Panama. Data were compiled in a bespoke Access database. Plant names from the published sources were validated against The Plant List (TPL, (The Plant List, 2013) [2]) and accepted names and synonyms were extracted. In total, the database includes 607 plant names obtained from the published sources which correspond to 537 plant taxa, 9271 synonyms and 1055 use reports.

How informed is declared altruism in clinical trials? A qualitative interview study of patient decision-making about the QUEST trials (Quality of Life after Mastectomy and Breast Reconstruction).

BACKGROUND: Randomised controlled trials (RCTs) often fail to recruit sufficient participants, despite altruism being cited as their motivation. Previous investigations of factors influencing participation decisions have been methodologically limited. This study evaluated how women weigh up different motivations after initially expressing altruism, and explored their understanding of a trial and its alternatives. The trial was the 'Quality of Life after Mastectomy and Breast Reconstruction' (QUEST) trial. METHODS: Thirty-nine women participated in qualitative interviews 1 month post-surgery. Twenty-seven women (10 trial decliners and 17 acceptors) who spontaneously mentioned 'altruism' were selected for thematic analysis. Verbatim transcripts were coded independently by two researchers. Participants' motivations to accept or decline randomisation were cross-referenced with their understanding of the QUEST trials and the process of randomisation. RESULTS: The seven emerging themes were: (1) altruism expressed by acceptors and decliners; (2) overriding personal needs in decliners; (3) pure altruism in acceptors; (4) 'hypothetical altruism' amongst acceptors; (5) weak altruism amongst acceptors; (6) conditional altruism amongst acceptors; and (7) sense of duty to participate. Poor understanding of the trial rationale and its implications was also evident. CONCLUSIONS: Altruism was a motivating factor for participation in the QUEST randomised controlled trials where the main outcomes comprised quality of life and allocated treatments comprised established surgical procedures. Women's decisions were influenced by their understanding of the trial. Both acceptors and decliners of the trial expressed 'altruism', but most acceptors lacked an obvious treatment preference, hoped for personal benefits regarding a treatment allocation, or did not articulate complete understanding of the trial. TRIAL REGISTRATION: QUEST A, ISRCTN38846532 ; Date assigned 6 January 2010. QUEST B, ISRCTN92581226 ; Date assigned 6 January 2010.

Medicinal plants used in the traditional management of diabetes and its sequelae in Central America: A review.

ETHNOPHARMACOLOGICAL RELEVANCE: Globally 387 million people currently have diabetes and it is projected that this condition will be the 7th leading cause of death worldwide by 2030. As of 2012, its total prevalence in Central America (8.5%) was greater than the prevalence in most Latin American countries and the population of this region widely use herbal medicine. The aim of this study is to review the medicinal plants used to treat diabetes and its sequelae in seven Central American countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama. MATERIALS AND METHODS: We conducted a literature review and extracted from primary sources the plant use reports in traditional remedies that matched one of the following disease categories: diabetes mellitus, kidney disease, urinary problems, skin diseases and infections, cardiovascular disease, sexual dysfunctions, visual loss, and nerve damage. Use reports were entered in a database and data were analysed in terms of the highest number of use reports for diabetes management and for the different sequelae. We also examined the scientific evidence that might support the local uses of the most reported species. RESULTS: Out of 535 identified species used to manage diabetes and its sequelae, 104 species are used to manage diabetes and we found in vitro and in vivo preclinical experimental evidence of hypoglycaemic effect for 16 of the 20 species reported by at least two sources. However, only seven of these species are reported in more than 3 studies: Momordica charantia L., Neurolaena lobata (L.) R. Br. ex Cass., Tecoma stans (L.) Juss. ex Kunth, Persea americana Mill., Psidium guajava L., Anacardium occidentale L. and Hamelia patens Jacq. Several of the species that are used to manage diabetes in Central America are also used to treat conditions that may arise as its consequence such as kidney disease, urinary problems and skin conditions. CONCLUSION: This review provides an overview of the medicinal plants used to manage diabetes and its sequelae in Central America and of the current scientific knowledge that might explain their traditional use. In Central America a large number of medicinal plants are used to treat this condition and its sequelae, although relatively few species are widely used across the region. For the species used to manage diabetes, there is variation in the availability and quality of pharmacological, chemical and clinical studies to explain traditional use.

Ethnomedicinal uses of plants in the treatment of paediatric geohelminth infections in Kalat district of Northern Balochistan, Pakistan.

ETHNOPHARMACOLOGICAL RELEVANCE: Infection by intestinal parasitic worms (soil-transmitted helminths or geohelminths) is prevalent in many parts of the world, and poses a particular health risk to children. This paper presents findings from a preliminary study with the primary aim to document indigenous knowledge about the use of herbal medicines in the treatment of intestinal worm infections in children among the local communities of Kalat district of northern Balochistan, Pakistan. MATERIALS AND METHODS: Ethnomedicinal data were collected through a triangulation approach, that included participant-observation and rapid appraisal methods. Prior-informed consent (PIC) was obtained from participants before conducting structured and semi-structured interviews and delivering an open ended questionnaire. A total of 94 participants, including 28 men (of whom 7 were traditional healers), and 66 women of four different age groups were interviewed. Results were analyzed using quantitative indices of Use Value citations (UVC) and Disease-Consensus Index (DCI). RESULTS: Fewer men than women agreed to be interviewed, thus overall women in the area appeared to have more ethnomedicinal knowledge. The majority of study participants belonged to the older age group (>55 years). A total of 49 plant species, belonging to 47 genera, distributed in 30 families were reported. The families Asteraceae and Lamiaceae were most frequently represented, with four species each. Trees were the most common life form, with seeds the most frequently cited plant part used (29%). Nearly a third (31%) of plant-based remedies reported in the treatment of intestinal worms were administered as a decoction. The highest UVC and DCI was reported for the species Ferula assa-foetida sL. (UVC 0.51, DCI 0.46). CONCLUSIONS: This study provides previously unreported data on the use of medicinal plants in the treatment of geohelminth infections in children of Kalat. Eight species, Acacia modesta Wall., Asparagus capitatus Baker, Microcephala lamellata (Bunge) Pobed., Nepeta praetervisa Rech.f., Plantago ciliata Desf., Pistacia atlantica Desf., Seriphidium quettense (Podlech) Y.R.Ling and Thymus linearis Benth. are reported here as anthelmintics for the first time. Detailed studies on the anthelmintic activity of chemical constituents of these species are lacking from existing literature. Further phytochemical, pharmacological and toxicity studies are required in order to evaluate the efficacy and safety of these newly reported anthelmintic species. These plants may provide a source of novel anthelmintic drug leads, which are urgently required due to the problem of global anthelmintic resistance.

Reconstructing communities in cluster trials?

BACKGROUND: There is growing interest in the ethics of cluster trials, but no literature on the uncertainties in defining communities in relation to the scientific notion of the cluster in collaborative biomedical research. METHODS: The views of participants in a community-based cluster randomised trial (CRT) in Mumbai, India, were solicited regarding their understanding and views on community. We conducted two focus group discussions with local residents and 20 semi-structured interviews with different respondent groups. On average, ten participants took part in each focus group, most of them women aged 18-55. We conducted semi-structured interviews with ten residents (nine women and one man) lasting approximately an hour each and seven individuals (five men and two women) identified by residents as local leaders or decision-makers. In addition, we interviewed two Municipal Corporators (locally elected government officials involved in urban planning and development) and one representative of a political party located in a slum community. RESULTS: Residents' sense of community largely matched the scientific notion of the cluster, defined by the investigators as a geographic area, but their perceived needs were not entirely met by the trial. CONCLUSION: We examined whether the possibility of a conceptual mismatch between 'clusters' and 'communities' is likely to have methodological implications for a study or to lead to potential social disharmony because of the research interventions, arguing that it is important to take social factors into account as well as statistical efficiency when choosing the size and type of clusters and designing a trial. One method of informing such a design would be to use existing forums for community engagement to explore individuals' primary sense of community or social group and, where possible, to fit clusters around them. TRIAL REGISTRATION: ISRCTN Register: ISRCTN56183183 Clinical Trials Registry of India: CTRI/2012/09/003004 .

Making maternal health services accessible to all cultures.

Childbirth poses a much greater risk for women in developing countries than it does for those in wealthy ones, but there are also huge disparities in health within developing countries. Complications and death from childbirth and pregnancy-related causes are much more common amongst women from cultural and ethnic minority groups than women from mainstream cultures. This article explores the reasons behind the disparity and suggests some solutions, including culturally appropriate health services, and training women from minority communities to act as a cultural bridge and ensure women access state health services.

A reappraisal of herbal medicinal products.

Complementary and alternative medicine is increasingly popular, and encompasses a number of systems and therapies based on diverse theories and practices, such as homoeopathy, traditional herbalism, reiki, ayurvedic medicine and traditional Chinese medicine. While many are based on metaphysical concepts for which there is no sound evidence, for herbal medicines there is a rational, scientific basis and increasing clinical evidence. This article suggests herbal medicines should no longer be considered part of CAM, but instead sit alongside conventional medicines.

Metabolomic analysis of Ranunculus spp. as potential agents involved in the etiology of equine grass sickness.

Identification of toxic or harmful agents continues to be a key goal in agricultural chemistry. This paper reports a metabolomic analysis of Ranunculus repens and related species, which were recently postulated to be cocausative agents in the etiology of equine grass sickness (EGS). Specifically, samples collected at EGS sites were compared with those from non-EGS sites. Furthermore, interspecific and seasonal variations and the species' response to edaphic and climatic factors were investigated. (1)H NMR spectroscopy in combination with multivariate data analysis was applied to the crude methanol extracts of the Ranunculus samples, as well as their chloroform fractions. Samples from EGS sites were significantly different from control samples. The metabolite composition varied greatly between different Ranunculus species. No significant changes could be observed between samples collected in different seasons. This work provides strong evidence that Ranunculus is involved in the etiology of EGS and has implications for agricultural management of pastures.

Ethnopharmacological field studies: a critical assessment of their conceptual basis and methods.

Ethnopharmacology as a well-defined field has a relatively short history, but for centuries researchers have been interested in the observation, description, and experimental investigation of indigenous drugs and their biological activities. Today, such articles are published in a variety of journals among which the Journal of Ethnopharmacology has a prominent position as well as in book monographs. As any other area of scientific endeavour, this field requires a critical and engaged discussion about the conceptual basis, the relevant methods and the overall standards necessary for excellence. Here we review recent ethnopharmacological field studies in order to highlight achievements and future needs for improving the quality of such studies. The basis for this review is 40 field studies published in the years 2007 and 2008 in the Journal of Ethnopharmacology. Researchers need to have a clear vision for what and how they want to achieve a conceptually and methodologically sound approach and as in all disciplines adherence to internationally recognized methodological standards is essential. Here we review not only the basic conceptual requirements but also the minimal methodological (i.e. botanical, anthropological/historical,ethnomedical) standards and ways how to quantify ethnopharmacological information. Future uses of such information both in the context of experimental research and in applied projects highlight the multiple roles of such data generated in ethnopharmacological field studies. This review cannot be a book of recipes on how to conduct such research but highlights minimal conceptual and methodological requirements for use in future projects.

Combination treatment of human umbilical cord matrix stem cell-based interferon-beta gene therapy and 5-fluorouracil significantly reduces growth of metastatic human breast cancer in SCID mouse lungs.

Umbilical cord matrix stem (UCMS) cells that were engineered to express interferon-beta (IFN-beta) were transplanted weekly for three weeks into MDA 231 breast cancer xenografts bearing SCID mice in combination with 5-fluorouracil (5-FU). The UCMS cells were found within lung tumors but not in other tissues. Although both treatments significantly reduced MDA 231 tumor area in the SCID mouse lungs, the combined treatment resulted in a greater reduction in tumor area than by either treatment used alone. These results indicate that a combination treatment of UCMS-IFN-beta cells and 5-FU is a potentially effective therapeutic procedure for breast cancer.

Reluctance to seek help and the perception of anxiety and depression in the United kingdom: a pilot vignette study.

We investigated if reluctance to seek help could be explained by how people perceive an illness. Participants were members of the general public who had experienced mental health problems, for which approximately half had sought professional help. We asked them to rate the problems of 2 vignette characters using the Brief Illness Perception Questionnaire (BIPQ). Participants who had sought help were more likely to see the problems of the vignette characters as having more serious consequences and to understand their problems better, compared with those who had not sought help. The depression vignette character was seen as having a problem that was more serious but less amenable to treatment compared with the anxiety vignette character. Compared with men, women were likely to be more aware of the consequences and chronicity of depression. We conclude illness perceptions may help explain reluctance to seek help and discuss implications for encouraging consultation.

Questionnaire surveys: methodological and epistemological problems for field-based ethnopharmacologists.

The classical scientific approach is empirical. One of the favoured means of gathering quantitative data in the health and social sciences, including ethnopharmacology and medical ethnobotany, is by use of questionnaires. However, while there are numerous published articles discussing the importance of questionnaire content, the fact that questionnaires themselves may be inappropriate in a number of cultural contexts, even where literacy is not a factor, is usually ignored. In this paper, the authors will address the main issues posed by the use of questionnaire surveys, using case studies based on their own personal experiences as ethnopharmacologists 'in the field'. The pros and cons of qualitative and quantitative research and the use of alternative means to elicit quantitative data will be discussed.

Recruitment strategies for a clinical trial of community-based water therapy for osteoarthritis.

This study compares the efficiency of two methods of recruitment into a randomised controlled trial examining the cost-effectiveness of water therapy for elderly people with lower limb osteoarthritis. The direct cost of recruiting patients via general practice was 27.66 Pounds per patient (1.1 personnel hours/patient). The cost per recruited patient from a local newspaper article was 2.72 Pounds (0.2 personnel hours/patient). The cost differential between the two recruitment methods was largely owing to poor administration practices, difficulties in accessing patient information, and difficulties in contacting patients from the general practice computer database.