Diagnoses associated with dietary supplement use in a national dataset.

OBJECTIVES: The purpose of this study was to determine if participant diagnosis, as determined by a health care provider, is associated with dietary supplement (DS) use. DESIGN/SETTING: Surveys from 1255 study participants aged 34-84, part of the Midlife in the US Study (MIDUS 2 Survey) Biomarker Project, were reviewed. Participant data included pharmaceutical use (prescription and over-the-counter medications (OTC)), clinical symptoms and diagnosis, and laboratory results. Associations were calculated between the above participant characteristics and DS use. MAIN OUTCOME MEASURES: Frequency of DS use for physician-reported diagnoses. RESULTS: Overall prevalence of DS use was 32.4%. Participants taking DS were more often female (p = .048), white (p < 0.001), and older (mean age 57 years, p < 0.001). Participants taking DS reported taking more OTC (p < .001) and prescription medications (p = .024), and had an increased number of chronic conditions (p = .004). Participants reporting physician-diagnosed diabetes were significantly less likely to be taking DS (p = .0066), while participants with eye disease (p = .001), high cholesterol (p = 0.041), cancer (p = 0.042), and arthritis (p = 0.044) were more likely to be taking DS than those without those conditions. No difference in DS use was found between patients with and without other identified medical conditions. After adjusting for age, race/ethnicity, and gender, only diabetes remained a significant predictor of decreased DS use (OR 0.588, CI 0.388-0.873, p = .01). CONCLUSIONS: Some physician-reported participant diagnoses were associated, positively or negatively, with DS use.

Impact of a Clinical Educational Effort in Driving Transformation in Health Care.

BACKGROUND AND OBJECTIVES: The purpose of this study was to assess whether a 2.5 day clinical education course focused on integrative medicine (IM), complementary health (CH), and patient-centered care strategies delivered to staff at Veteran Health Administration (VHA) facilities resulted in changes in attitudes, self-efficacy, preparedness, intentions, and self-reported use of IM strategies. The study also assessed whether there were differential impacts by participant characteristics. METHODS: The study used a pre-post intervention group-only design with participants who completed self-report pre, post, and 2-month follow-up surveys. The course was delivered to 15 VHA facilities, reaching a total of 655 participants with 407 participants completing the 2-month follow-up survey (65% response rate). RESULTS: Findings suggest that the clinical course was associated with changes in all outcomes at the 2-month follow-up, including attitudes, self-efficacy to engage in IM strategies, institutional support, perceived preparedness to discuss non-pharmaceutical approaches to care, intentions to engage in IM strategies, and greater engagement in IM behaviors during clinical encounters. Differential impacts were found for younger participants, longer tenured staff, non-nursing compared to nursing staff, and among those who volunteered as opposed to those who were required to attend. DISCUSSION AND CONCLUSIONS: The study found significant positive changes in all outcomes measured at the 2-month follow-up. Positive impacts were found across a variety of participant characteristics. Findings suggest that this brief experiential course, designed to be a foundational strategy in driving transformation is effective in shifting attitudes, self-efficacy, preparedness, intentions, and self-reported use of IM strategies.

A pilot study of herbal medicine use in a Midwest Latino population.

BACKGROUND: Herbal medicine use is common in the United States, especially in immigrant populations. Understanding of this plant use is incomplete, with significant gaps in the literature for people living in the Midwest, about the plant species used, and about how home herbal medicine use interacts with allopathic medicine. METHODS: This pilot project used a qualitative research approach (interviews and focus groups, convenience sampling) to explore this topic for Latin America immigrants living in Madison, Wisconsin. RESULTS: Eight interviews and focus groups consisting of 42 people yielded 199 minutes of audio recordings and the mention of 57 medicinal plants. These plants were obtained from gardens, relatives and friends (abroad and local), mail order, and local retail establishments. Retail sites sold fresh plants, dried plants, spices, foods, and packaged products, ranging from 20 to over 150 plant products per site. A preponderance of plants, especially in Latino-focused stores, was food that also served a medicinal purpose. Participants mentioned 35 distinct health and disease categories for which herbal medicines were used, and sometimes, but not always, discussed plant use with their health care provider. When compared with likely Latin binomial taxonomic names, clinically relevant confusions with the use of common plant names also were identified. DISCUSSION: Overall, the findings presented illustrate the complexities surrounding herbal medicine use and create a case for future work to involve other demographics, and focus on botanical identification, the quantification of disclosure rates, and the development of educational interventions for physicians and patients.

The Overlap of Dietary Supplement and Pharmaceutical Use in the MIDUS National Study.

Introduction. In the United States, dietary supplement (DS) use is common, often takes place outside of the purview of health care providers, and may involve DS in combination with pharmaceuticals. This situation has led to concerns about interactions between DS and pharmaceuticals, as well as the risks from polypharmacy and polysupplement use. Methods. We used data from the Midlife in the US study (MIDUS 2 Survey) to examine DS and prescription pharmaceutical use in 3876 study participants in order to determine the demographics of high-users (5 or more) of DS and pharmaceuticals and the presence of DS-pharmaceutical co-use. Results. Over 69% of study participants regularly used DS, 49.6% regularly used both DS and pharmaceuticals, and 6.3% and 8.7% were high-users of pharmaceuticals and DS, respectively. High-users of DS, pharmaceuticals, and either were more likely than the whole cohort to be female and of lower income. Conclusions. These findings corroborate those of other national studies with respect to the demographics of DS users but add new information about people at risk of DS-pharmaceutical interactions, not an insignificant proportion of the population examined by this dataset.

Echinacea for preventing and treating the common cold.

BACKGROUND: Echinacea plant preparations (family Asteraceae) are widely used in Europe and North America for common colds. Most consumers and physicians are not aware that products available under the term Echinacea differ appreciably in their composition, mainly due to the use of variable plant material, extraction methods and the addition of other components. OBJECTIVES: To assess whether there is evidence that Echinacea preparations are effective and safe compared to placebo in the prevention and treatment of the common cold. SEARCH METHODS: We searched CENTRAL 2013, Issue 5, MEDLINE (1946 to May week 5, 2013), EMBASE (1991 to June 2013), CINAHL (1981 to June 2013), AMED (1985 to February 2012), LILACS (1981 to June 2013), Web of Science (1955 to June 2013), CAMBASE (no time limits), the Centre for Complementary Medicine Research (1988 to September 2007), WHO ICTRP and clinicaltrials.gov (last searched 5 June 2013), screened references and asked experts in the field about published and unpublished studies. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing mono-preparations of Echinacea with placebo. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed eligibility and trial quality and extracted data. The primary efficacy outcome was the number of individuals with at least one cold in prevention trials and the duration of colds in treatment trials. For all included trials the primary safety and acceptability outcome was the number of participants dropping out due to adverse events. We assessed trial quality using the Cochrane 'Risk of bias' tool. MAIN RESULTS: Twenty-four double-blind trials with 4631 participants including a total of 33 comparisons of Echinacea preparations and placebo met the inclusion criteria. A variety of different Echinacea preparations based on different species and parts of plant were used. Evidence from seven trials was available for preparations based on the aerial parts of Echinacea purpurea. Ten trials were considered to have a low risk of bias, six to have an unclear risk of bias and eight to have a high risk of bias. Ten trials with 13 comparisons investigated prevention and 15 trials with 20 comparisons investigated treatment of colds (one trial addressed both prevention and treatment).Due to the strong clinical heterogeneity of the studies we refrained from pooling for the main analysis. None of the 12 prevention comparisons reporting the number of patients with at least one cold episode found a statistically significant difference. However a post hoc pooling of their results, suggests a relative risk reduction of 10% to 20%. Of the seven treatment trials reporting data on the duration of colds, only one showed a significant effect of Echinacea over placebo. The number of patients dropping out or reporting adverse effects did not differ significantly between treatment and control groups in prevention and treatment trials. However, in prevention trials there was a trend towards a larger number of patients dropping out due to adverse events in the treatment groups. AUTHORS' CONCLUSIONS: Echinacea products have not here been shown to provide benefits for treating colds, although, it is possible there is a weak benefit from some Echinacea products: the results of individual prophylaxis trials consistently show positive (if non-significant) trends, although potential effects are of questionable clinical relevance.

An overview of CAM: components and clinical uses.

Complementary and alternative medicine (CAM), more recently known as integrative health or integrative medicine, is a diverse field comprising numerous treatments and practitioners of various levels of training. This review defines several of the main CAM modalities and reviews some of the research relevant to their clinical application. The goal is to provide healthcare providers with a basic understanding of CAM to start the incorporation of proven treatments into their clinical practice as well as guide them to working with CAM providers; ultimately, such knowledge is a fundamental part of a collaborative approach to optimal patient health and wellness.

Panax ginseng.

The herbal remedies referred to as "ginseng" are derived from the roots of several plants. One of the most commonly used and researched of the ginsengs is Panax ginseng, also called Asian or Korean ginseng. The main active components of Panax ginseng are ginsenosides, which have been shown to have a variety of beneficial effects, including anti-inflammatory, antioxidant, and anticancer effects. Results of clinical research studies demonstrate that Panax ginseng may improve psychologic function, immune function, and conditions associated with diabetes. Overall, Panax ginseng appears to be well tolerated, although caution is advised about concomitant use with some pharmaceuticals, such as warfarin, oral hypoglycemic agents, insulin, and phenelzine. Panax ginseng does not appear to enhance physical performance. Products with a standardized ginsenoside concentration are available.