Mental health and use of Medicare Benefits Schedule follow-up mental health services by Indigenous people in Australia during the COVID-19 pandemic.

Background: Mental health care has declined during the COVID-19 pandemic as has attendance for preventive mental health health services. This study aimed to investigate trends in all types of mental health service claims identified in an Indigenous-specific health assessment for Indigenous people before and during COVID-19. Methods: We conducted an analysis of Medicare Benefits Scheme (MBS) mental health service items (Items 81,325 and 81,355), to investigate the trends in all types of mental health service claims specifically intended for Indigenous people of Australia. Data were analysed using descriptive statistics, including the total annual numbers of Indigenous peoples' mental health service claims cross-tabulated by age groups and gender, between the calendar years 2017-2021. Multivariable Poisson regression modelling was used to determine associations that were statistically significant. Results: Our results indicate an overall rise in MBS claims for mental health follow-up services during 2019-2020 followed by a decline in 2020-2021. In addition, there was an overall decline in claims for follow-up psychology services across the time period 2019-2021. Conclusion: We found a significant decline in MBS items specific to follow-up mental health services (MBS Items 81,325 and 81,355) for Indigenous people in Australia suggesting a decline in attendance for mental health service follow-up which in turn may indicate a deficit in mental health care during the COVID-19 pandemic, an issue that may lead to poorer mental health outcomes in the future. Further research is needed to understand whether these changes were due to the impact of the COVID-19 pandemic or other factors.

The health care utilisation and out-of-pocket expenditure associated with Australian stroke survivors aged 55 and over.

OBJECTIVE: Stroke is a major cause of mortality and disability worldwide. People with stroke have a number of options available to treat post-stroke related symptoms and challenges. The aim of this study was to assess the use of healthcare services, self-care practices and out-of-pocket expenses associated with post-stroke healthcare. METHODS: We retrospectively analysed data collected between April and October 2017 from a survey of 576 participants aged 55 to 96 from the 45 and Up Study, NSW (Australia), who had earlier reported a clinical diagnosis of stroke. Participants were asked about their use of health care services, including conventional medicine practitioners and medications, complementary medicine practitioners, practices and products and the respective associated out-of-pocket expenditure for each. RESULTS: Amongst the total of 576 individuals who participated in the study, 39% consulted a doctor, 18% consulted an allied health practitioner, and 8% consulted a complementary medicine practitioner in the previous year for their stroke. Participants' average combined out-of-pocket expenditure for post-stroke related healthcare was AU$386.4 per annum. Extrapolated to all Australians with stroke, aged 55 years and over, the total out-of-pocket expenditure for post-stroke related healthcare is estimated to be AU$42 million per annum. CONCLUSIONS: Post-stroke individuals used a wide range of health services and various self-care practices for stroke rehabilitation. Such healthcare utilisation is associated with significant annual out-of-pocket expenditure. Given the socioeconomic burden of stroke, further research is required to identify the barriers and facilitators of self-care among patients with stroke and explore the cost-effectiveness of the wide range of treatments(s) utilised for post-stroke care.

A Network Pharmacology Study on the Active Components and Targets of the Radix Ginseng and Radix Bupleuri Herb Pair for Treating Nonalcoholic Fatty Liver Disease.

OBJECTIVE: To explore the potential active components and corresponding target herb pairs of Radix Ginseng (Renshen) and Radix Bupleuri (Chaihu) in the treatment of nonalcoholic fatty liver disease (NAFLD) through network pharmacology and in vitro experiments. METHODS: The active components and potential targets of the herb pair of Renshen and Chaihu were screened through a network database system, and Venn analysis was performed with the obtained NAFLD targets. The intersecting targets were analysed for gene ontology (GO) functions and Kyoto Encyclopedia of Genes and Genome (KEGG) pathways, and a protein-protein interaction (PPI) network was generated. Cytoscape software was used to construct active component-target networks of the Renshen and Chaihu herb pair. Free fatty acids were added to the HepG2 cell line to create high-fat models that were treated with different concentrations of stigmasterol. The effect of stigmasterol on the lipid metabolism in HepG2 cells and PPARγ-knockdown cells was determined by oil red O staining, Nile red staining, and TG level. PPARγ and UCP-1 mRNA, and protein expression levels were detected by qRT-PCR and Western blot analyses, respectively. RESULTS: Twenty active components obtained from the Renshen and Chaihu herb pair were identified. The herb pair active component-target network showed that both Renshen and Chaihu contained stigmasterol and kaempferol as active components. The PPI network comprised 63 protein nodes. GO enrichment analysis and KEGG pathway enrichment analysis showed that the targets were mainly involved in lipid metabolism. Eight core targets were identified: AKT1, PPARG, MAPK3, TNF, TP53, SIRT1, STAT3, and PPARA. In vitro experiments demonstrated that stigmasterol reduced lipid accumulation and TG levels in HepG2 cells, and the mechanism may have been related to the activation of the PPARγ-UCP-1 signalling pathway. CONCLUSION: This study preliminarily illustrated the potential components and corresponding core targets of the Renshen and Chaihu herb pair in treating NAFLD. The effect of stigmasterol on the PPARγ-UCP-1 signalling pathway in enhancing lipid metabolism may represent one of the mechanisms of the Renshen and Chaihu herb pair in the treatment of NAFLD. The results provide new evidence and research insights to reveal the roles of Renshen and Chaihu in the management of NAFLD.

Practitioner and practice characteristics of Australian osteopaths who discuss lifestyle factors with patients: Findings from a national practice-based research network.

Healthcare professionals' advice on lifestyle behaviours is a key factor in improving a nation's health. Although allied health professionals have been well placed to provide such advice as part of patient care, little is known about the characteristics of allied health practitioners who discuss lifestyle topics with patients. This paper focused upon an overlooked avenue for lifestyle advice regarding an allied health profession - osteopathy. A workforce survey including questions about four lifestyle topics (including diet/nutrition, smoking/drugs/alcohol, physical activity/fitness, and stress management) was distributed to a nationally representative sample of Australian registered osteopaths in 2016. Separate multivariate logistic regression and Poisson regression models were developed to determine the most important predictors of the discussion of lifestyle factors. Amongst the 992 participating osteopaths, 89%, 49%, 38%, and 18% often discussed physical activity/fitness, stress management, diet/nutrition, and smoking/drugs/alcohol with their patients, respectively. Approximately 30% of participating osteopaths discussed at least three lifestyle topics with patients. Varied predictors were identified for discussing each lifestyle topic. Osteopaths who often discuss diet/nutrition in patient management plans were more likely to often discuss smoking/drugs/alcohol (OR = 14.13), physical activity/fitness (OR = 2.71), and/or stress management (OR = 1.69). In conclusion, lifestyle factors are often discussed with patients as part of osteopathy treatments in the Australian healthcare context. Osteopaths are well positioned to initiate discussions regarding patient lifestyles, and such discussions may be an effective contribution to health promotion.

The Regulation of the Complementary Health Sector: General Public's Knowledge of Complementary Medicine-Related Quality Assurance and Consumer Protection.

BACKGROUND: Complementary medicine (CM) use is a ubiquitous aspect of an increasingly consumer-driven model of healthcare delivery and plays an increasingly prominent role in the Australian health sector. Yet there is limited empirical research investigating the quality and integrity of protections for consumers in Australia. The aim of this study is to help address this gap in knowledge by exploring how members of the public engage with protection mechanisms related to CM use. METHODS: This study utilised a cross-sectional online survey to recruit a sample of 1132 Australian adults aged 18 and over. Purposive convenience sampling was used to recruit participants from an existing database of Australian adults who had expressed interest in participating in research. RESULTS: The majority of the participants (64.0%) had visited a CM practitioner in their lifetime. However, a minority of participants (36.9%) indicated they would feel confident in knowing where to complain if something went wrong with the treatment they received from a CM practitioner. Most participants (74.7%) had used a CM product in their lifetime. Specifically, 32.3% had 'ever' used an herbal product and 69.9% had 'ever' used a nutritional supplement. However, a minority of participants (32.7%) indicated they would feel confident knowing where to complain if something went wrong with a herbal or nutritional supplement they used. Most participants indicated a lack of knowledge about how CM practitioners and CM products are regulated in Australia. CONCLUSION: The findings of this study clearly highlight a concerning lack of knowledge by CM patients and consumers regarding the regulation of CM in Australia. From a policy perspective, it is necessary to seek proactive approaches that target complaint-related knowledge of the CM patients and consumers through education and advocacy efforts.

Design characteristics of comparative effectiveness trials for the relief of symptomatic dyspepsia: A systematic review.

BACKGROUND: Dyspepsia represents a symptom domain rather than a diagnostic condition and covers a wide range of complex, underlying pathophysiologies that are not well understood. The review explores comparative effectiveness interventions for the treatment of symptomatic dyspepsia along a pragmatic-explanatory continuum. The aim is to identify relevant design characteristics applicable to future upper gastrointestinal comparative effectiveness research employing integrative medicine. METHODS: Medline, CINAHL, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and WHO Clinical Trials were systematically searched until January 2019. Included articles were original research with two or more comparative intervention arms for the primary outcome; relief of symptomatic dyspepsia. Evaluation of the studies was conducted using the pragmatic-explanatory continuum indicator summary (PRECIS-2) tool. RESULTS: Thirty-six articles were included in the review. A total of 68 Patient Reported Outcome Measurements (PROMs), utilizing 50 different formats were deployed across the studies. The appraisal process revealed eligibility, flexibility in adherence, flexibility in delivery and organization domains further aligned towards an explanatory design. CONCLUSION: This review identified three design characteristics relevant for future comparative effectiveness research for the treatment of upper gastrointestinal disorders in a community setting. Extensive exclusion eligibility criteria limited the generalization of comparative effectiveness study results by removing sub-groups of the target populations more at risk of dyspeptic symptoms. The requirement for entry endoscopy was found to be common and not always pragmatically justifiable. Development of validated PROMs appropriate for a generic application to upper gastrointestinal disorders would be advantageous for future comparative effectiveness research within integrative medicine.

Prevalence and Factors Associated With Body Pain: Results of a Nationally Representative Survey of 9,586 Chinese Adults Aged 60 and Over.

Background: Pain management has become a critical problem worldwide with the aging population. More than half of older people have experienced pain with different severity. The aim of this research is to identify the characteristics of older people with body pain and the associations between pain and characteristics of demographic, health status, and health services use amongst Chinese seniors. Methods: This cross-sectional study was based on the China Health and Retirement Longitudinal Study (CHARLS), using follow-up survey data in 2015. The national survey comprised 20,284 women and men aged 45 years or older who completed questionnaires. Data of older people who were asked whether they had troubles with body pain were extracted and analyzed. Multiple logistic regression modeling was used to determine the important indicators (demographic, health status, and health services use) amongst Chinese elderly with pain. Results: Analyses revealed that 32.5% (n = 9,586) of Chinese people aged over 60 reported having body pain. Pain is positively associated with female gender (OR = 2.08, 95% CI 1.80-2.39, p < 0.001), living in non-urban areas (OR = 1.49, 95% CI 1.25-1.77, p < 0.001), having physical disabilities (OR = 1.45, 95% CI 1.15-1.82, p = 0.002), diagnosed with stomach diseases (OR = 1.40, 95% CI 1.20-1.64, p < 0.001), diagnosed with arthritis (OR = 1.91, 95% CI 1.66-2.20, p < 0.001), self-rating with poor health status (OR = 7.03, 95% CI 5.63-8.78, p < 0.001), self-purchased over-the-counter western medications (OR = 1.50, 95% CI 1.30-1.73, p < 0.001) and self-purchased Chinese herbal medicine (OR = 1.52, 95% CI 1.24-1.85, p < 0.001). Conclusion: Body pain is common amongst the Chinese elderly. This research highlights the need for further nationwide studies exclusively focusing on people with pain including the elder population, and provides evidence-based insights for healthcare providers and policy-makers, to improve the quality of pain management. Future research should also pay attention to the importance of health literacy for health outcomes with regard to pain management.

Health care utilisation and out-of-pocket expenditure associated with hypertension: an analysis of Australian adults from the 45 and Up Study.

Hypertension is a common condition worldwide that significantly increases morbidity and mortality rates in the older population. A number of treatment options are available to control blood pressure. The purpose of this study was to assess the use of health services and self-care amongst people with hypertension and to estimate the out-of-pocket expenses associated with such health care use. A sub-study of the 45 and Up Study was conducted amongst 1300 individuals who had earlier reported a clinical diagnosis of hypertension in 2017. A total of 753 (57.9%) individuals with hypertension returned a completed questionnaire. In the last 12 month, for their hypertension management, 84% of participants consulted a doctor, 19% of them consulted an allied health practitioner and 9% of them consulted a complementary medicine practitioner. The average total out-of-pocket expenditure for hypertension-related health care was Australian $461.8 per annum, with an estimated Australian $941 million per annum if extrapolated to all Australians aged 55 years and over with hypertension. Older people with hypertension use a wide range of health services to control their blood pressure including conventional medicine, allied health and complementary medicine practitioners as well as various self-care practices. A substantial amount of out-of-pocket expenditure has been spent on hypertension care annually. Given the global health and economic burden of hypertension, there is an urgent need for more research exploring cost-effective management(s) for hypertensive patients.

The prevalence and determinants of physical activity promotion by Australian chiropractors: A cross sectional study.

BACKGROUND: Approximately one in four adults do not meet the World Health Organisation physical activity recommendations. While health promotion (i.e., physical activity) is common within chiropractic settings, little is known about chiropractors discussing this public health issue with their patients. The aim of our study is to examine the prevalence and characteristics of Australian chiropractors who frequently discuss patient physical activity. METHODS: A national cross-sectional survey of chiropractors focusing upon practitioner characteristics, practice settings and clinical management characteristics. Regression analyses were conducted on 1924 survey respondents to identify factors associated with practitioners who frequently discuss physical activity with patients. RESULTS: Eighty-five percent of Australian chiropractors reported 'often' discussing physical activity as part of their patient management. The strongest factors associated with chiropractors who frequently discuss physical activity obtained from the multivariate analysis include: often discussing occupational health and safety (odds ratio [OR] = 6.10; 95%CI: 3.88, 9.59), often discussing diet/nutrition (OR = 4.56; 95%CI: 3.12, 6.66), often discussing smoking/drugs/alcohol (OR = 4.41; 95%CI: 2.06, 9.40), often use of specific exercise therapy/rehabilitation/injury taping (OR = 3.76; 95%CI: 2.62, 5.39) and often caring for athletes or sports people (OR = 2.18; 95%CI: 1.56, 3.06) within their practice setting. CONCLUSION: Discussing physical activity is a frequent feature of patient management among most chiropractors in Australia. The association between these practitioners and discussion of other costly public health burdens could suggest chiropractors have a valuable role to play in chronic disease prevention. Given the growing need for practitioner-led promotion of patient physical activity further research examination of the role and contribution of chiropractors in promoting this important public health topic among patients and communities is needed.

Impact of evidence-based healthcare education for Chinese medicine practitioners: A pre-post evaluation.

WHO Traditional Medicine Strategy 2014-23 recommended evidence-based healthcare (EBHC) education for traditional and complementary medicine (T&CM) professionals, including Chinese medicine practitioners (CMPs). We evaluated the impact of a customized educational workshop on Hong Kong CMPs' knowledge, attitude and practice of EBHC. Two validated instruments, Evidence-based Practice Questionnaire (EPQ) and Evidence-based Practice Inventory (EPI), were used to assess the impact of EBHC education. Paired t-tests were used to compare scores before and after the workshop. Multiple linear regression was performed to explore the associations between changes in EPQ/EPI scores and CMPs' characteristics. CMPs who completed the workshop (n = 59) demonstrated significant improvements in the attitude (p = 0.013) and knowledge domains of the EPQ (p = 0.005). Significant improvements were also observed in the attitude, perceived behavioural control, decision making, and intention and behaviour domains of the EPI. CMPs who had never received prior EBHC training showed a larger magnitude of improvement in the EPI attitude (p = 0.032), decision making (p = 0.015), and intention and behaviour (p = 0.015) domains post-workshop. Our findings suggest that tailored workshop is effective in strengthening knowledge and in improving attitudes towards EBHC. Future RCTs should be conducted to affirm our findings. Future initiatives may consider incorporating this education approach into CMP curricula, as well as facilitating implementation of EBHC in routine Chinese medicine practice.

Characteristics of chiropractors who manage people aged 65 and older: A nationally representative sample of 1903 chiropractors.

OBJECTIVE: To examine the prevalence and profile of chiropractors who frequently manage people aged 65 years and older. METHODS: A national cross-sectional survey collected practitioner characteristics, practice settings and clinical management characteristics. Multiple logistic regression was conducted on 1903 chiropractors to determine the factors associated with the frequent treatment of people 65 years and older. RESULTS: In total, 73.5% of participants report "often" treating those aged 65 years and older. These chiropractors were associated with treating degenerative spine conditions (OR [odds ratio] 2.25; 95% [confidence interval] CI 1.72-2.94), working in a non-urban area (OR 1.85; 95% CI 1.35-2.54), treating low back pain (referred/radicular) (OR 1.74; 95% CI 1.26-2.40) and lower limb musculoskeletal disorders (OR 1.50; 95% CI 1.15-1.96). CONCLUSIONS: The majority of chiropractors report often providing treatment to older people. Our findings call for more research to better understand older patient complaints that are common to chiropractic practice and the care provided by chiropractors for this patient group.

The profile of chiropractors managing patients with low back-related leg pain: analyses of 1907 chiropractors from the ACORN practice-based research network.

Background: Approximately 60% of people with low back pain also have associated leg pain symptoms. Guidelines for low back pain recommend non-pharmacological approaches, including spinal manipulation - a therapy provided by chiropractors. However, limited empirical data has examined the characteristics of chiropractors managing patients with low back-related leg pain (LBRLP). Our objective is to describe the prevalence, profile and practice characteristics of Australian chiropractors who often treat LBRLP, compared to those who do not often treat LBRLP. Methods: This is a cross-sectional analysis of a nationally representative sample from the Australian Chiropractic Research Network (ACORN). This study investigated the demographic and practice characteristics as well as clinical management of chiropractors who 'often' treated patients with LBRLP compared to those who treated LBRLP 'never/rarely/sometimes'. Multiple logistic regression models identified independent factors associated with chiropractors who 'often' treated patients with LBRLP. Results: A total of 1907 chiropractors reported treating patients experiencing LBRLP, with 80.9% of them 'often' treating LBRLP. Chiropractors who 'often' treated LBRLP were more likely to manage patients with multi-site pain including axial low back pain (OR = 21.1), referred/radicular neck pain (OR = 10.8) and referred/radicular thoracic pain (OR = 3.1). While no specific management strategies were identified, chiropractors who 'often' treated LBRLP were more likely to discuss medication (OR = 1.8), manage migraine (OR = 1.7) and degenerative spine conditions (OR = 1.5), and treat women during pregnancy (OR = 1.6) and people with work-related injuries (OR = 1.5), compared to those not treating LBRLP frequently. Conclusions: Australian chiropractors frequently manage LBRLP, although the nature of specific management approaches for this condition remains unclear. Further research on the management of LBRLP can better inform policy makers and educators interested in upskilling chiropractors to deliver safe and effective treatment of LBRLP.

Prevalence and profile of Australian osteopaths treating older people.

OBJECTIVES: To explore the characteristics of the Australian osteopathy workforce who participate in the management of older patients with musculoskeletal complaints. DESIGN: Secondary analysis of a cross-sectional survey of osteopaths. SETTING: The Osteopathy Research and Innovation Network (ORION), an Australian practice-based research network. MAIN OUTCOME MEASURES: The demographic, practice and treatment characteristics of osteopaths who identify as 'always'or 'often' treating patients aged 65 years or over. RESULTS: Over half (58%) of total participants (n = 992) indicated often treating older people and this was associated with referral patterns with other health professionals and a non-urban practice location. Osteopaths providing care to older people were more likely to discuss diet/nutrition and medications, and provide pain counselling. Osteopaths who treated older adults were more likely to treat shoulder musculoskeletal disorders, degenerative spine disorders, chronic or persistent pain, and tendinopathies. CONCLUSIONS: A substantial proportion of Australian osteopaths treat older adults frequently. The potential value and impact of osteopathy in managing the health needs of an ageing population warrants close examination from both researchers and policy makers.

Complementary and alternative medicine research in practice-based research networks: A critical review.

AIMS: To provide a critical analysis of peer-reviewed literature reporting research from practice-based research networks (PBRNs) relating to complementary and alternative medicine (CAM). METHODS: A comprehensive literature search of peer-reviewed literature reporting PBRN research focusing upon CAM was conducted in PubMed, Ovid Medline, EMBASE, and CINAHL from their inceptions to June 2017. PBRN registry and websites of relevant PBRNs were also searched for further information. With regards to the nested PBRN studies included in our review, no study design restrictions were imposed and both empirical research and relevant methodologically-focused manuscripts were included. Methodological quality was evaluated via a number of established tools. RESULTS: A total of 51 articles reporting upon CAM research in PBRNs including six articles outlining CAM-focused PBRN establishment were included in the review. The findings of the literature were categorised as either: health services research (including work examining characteristics of patients and practices, doctor-patient communication, and CAM prevalence); effectiveness/safety research; or feasibility research. While 19 studies from non-CAM focused PBRNs tended to report on CAM prevalence and doctor-patient communication about CAM use, 26 articles from CAM-focused PBRNs reported on the characteristics of CAM users, practice patterns, and effectiveness/safety of CAM practice. DISCUSSION AND CONCLUSION: PBRNs - both CAM-focused and non-CAM focused - have provided a useful platform for research investigations around a number of core CAM-related issues. Given the increasing popularity of CAM use in healthcare and the identified benefits of practice-relevant research, further in-depth CAM research nested within PBRN designs is warranted.

Prevalence and practice characteristics of urban and rural or remote Australian chiropractors: Analysis of a nationally representative sample of 1830 chiropractors.

OBJECTIVE: To determine the prevalence and clinical management characteristics of chiropractors practising in urban and rural or remote Australia. DESIGN: A cross-sectional analysis of the Australian Chiropractic Research Network project data. SETTING: Nationally representative sample of registered chiropractors practising in Australia. PARTICIPANTS: Chiropractors who participated in the Australian Chiropractic Research Network project and answered a question about practising in urban or rural or remote areas in the practitioner questionnaire. MAIN OUTCOME MEASURE: The demographics, practice characteristics and clinical management of chiropractors. RESULTS: The majority of chiropractors indicated that they practise in urban areas only, while 22.8% (n = 435) practice in rural or remote areas only and 4.0% (n = 77) practice in both urban and rural or remote areas. Statistically significant predictors of chiropractors who practice in rural or remote areas, as compared to urban areas, included more patient visits per week, practising in more than one location, no imaging facilities on site, often treating degenerative spinal conditions or migraine, often treating people aged over 65 years, frequently treating Aboriginal and Torres Strait Islander people and frequently using biomechanical pelvic blocking or the sacro-occipital technique. CONCLUSION: A substantial number of chiropractors practice in rural or remote Australia and these rural or remote-based chiropractors are more likely to treat a wide range of musculoskeletal cases and include an Indigenously diverse group of patients than their urban-located colleagues. Unique practice challenges for rural or remote chiropractors include a higher workload and a lack of diagnostic tools. Chiropractors should be acknowledged and considered within rural or remote health care policy and service provision.

The Role and Influence of Traditional and Scientific Knowledge in Naturopathic Education: A Qualitative Study.

OBJECTIVES: To explore the perceptions, experiences, and attitudes toward scientific and traditional knowledge within contemporary naturopathic education. DESIGN: A qualitative focus group and semistructured individual interview study. SETTINGS/LOCATION: Naturopathic educational organizations and institutions in North America (United States/Canada) and Australia. SUBJECTS: Seven focus groups (three in Australia and four in the United States/Canada) involving a total of 29 students, and one-on-one interviews with 28 faculty and professional leaders of the naturopathic profession from Australia, Canada, and the United States. RESULTS: Four themes have been identified in this study, including finding the balance between traditional and scientific knowledge; supporting the balance through critical appraisal in the curriculum; the exception of traditional knowledge in the critical gaze; and focusing on critical thinking in the naturopathic curriculum. Both naturopathic students and leaders highlight the significance of balancing tradition and science in the naturopathic educational context, although they hold diverse differing viewpoints. The importance of critical appraisal skills as well as the differentiation between critical thinking and critical appraisal have also been emphasized by participants with regard to the future development of naturopathic curriculum. CONCLUSIONS: This is the first study focusing on the interface between traditional and scientific knowledge within the naturopathic education setting. The development of a framework for the critical appraisal of traditional naturopathic knowledge is required to help navigate the variety of knowledge sources available to naturopathic students and to help deliver the best outcomes for their future clinical practice.

Utilization of complementary and alternative medicine and conventional medicine for headache or migraine during pregnancy: A cross-sectional survey of 1,835 pregnant women.

OBJECTIVES: Little is known about women's use of health services affected by headache or migraine during pregnancy. This paper directly addresses the research gap reporting on the healthcare utilization among Australian pregnant women experiencing headache or migraine. DESIGN AND SETTING: In this retrospective observational study, data on 1,835 Australian pregnant women were obtained from the nationally-representative Australian Longitudinal Study on Women's Health. Information on quality of life and health seeking behaviors regarding conventional medicine and complementary and alternative medicine providers was identified among these participants. Factors associated with healthcare use were analyzed using regression analyses. RESULTS: A total of 16% of the pregnant women surveyed experienced headache or migraine, and over 20% sought help from more than two types of healthcare practitioners for their headache or migraine. General practitioners (37.8%) were the most commonly consulted providers of pregnant women for their headache or migraine. Women with headache or migraine during pregnancy had worse health-related quality of life than those without. Education level and private health insurance status of pregnant women are the predictors of the use of healthcare practitioners for their management of headache or migraine (both p < 0.05). CONCLUSIONS: Headache or migraine during pregnancy significantly impacts upon pregnant women's quality of life. The use of multiple healthcare practitioners, including conventional medicine and complementary and alternative medicine practitioners, highlights the need for further research investigating health services utilization of pregnant women with headache or migraine in different severity and frequency to help inform effective and safe treatment.

Efficacy of acupuncture for lifestyle risk factors for stroke: A systematic review.

BACKGROUND: Modifications to lifestyle risk factors for stroke may help prevent stroke events. This systematic review aimed to identify and summarise the evidence of acupuncture interventions for those people with lifestyle risk factors for stroke, including alcohol-dependence, smoking-dependence, hypertension, and obesity. METHODS: MEDLINE, CINAHL/EBSCO, SCOPUS, and Cochrane Database were searched from January 1996 to December 2016. Only randomised controlled trials (RCTs) with empirical research findings were included. PRISMA guidelines were followed and risk of bias was assessed via the Cochrane Collaboration risk of bias assessment tool. The systematic review reported in this paper has been registered on the PROSPERO (#CRD42017060490). RESULTS: A total of 59 RCTs (5,650 participants) examining the use of acupuncture in treating lifestyle risk factors for stroke met the inclusion criteria. The seven RCTs focusing on alcohol-dependence showed substantial heterogeneity regarding intervention details. No evidence from meta-analysis has been found regarding post-intervention or long-term effect on blood pressure control for acupuncture compared to sham intervention. Relative to sham acupuncture, individuals receiving auricular acupressure for smoking-dependence reported lower numbers of consumed cigarettes per day (two RCTs, mean difference (MD) = -2.75 cigarettes/day; 95% confidence interval (CI) = -5.33, -0.17; p = 0.04). Compared to sham acupuncture those receiving acupuncture for obesity reported lower waist circumference (five RCTs, MD = -2.79 cm; 95% CI: -4.13, -1.46; p<0.001). Overall, only few trials were considered of low risk of bias for smoking-dependence and obesity, and as such none of the significant effects in favour of acupuncture interventions were robust against potential selection, performance, and detection bias. CONCLUSIONS: This review found no convincing evidence for effects of acupuncture interventions for improving lifestyle risk factors for stroke.

Critical Review of Complementary and Alternative Medicine Use in Amyotrophic Lateral Sclerosis: Prevalence and Users' Profile, Decision-Making, Information Seeking, and Disclosure in the Face of a Lack of Efficacy.

BACKGROUND: Despite a lack of evidence of clinical efficacy for complementary and alternative medicine (CAM) use in amyotrophic lateral sclerosis (ALS), these medicines remain popular around the world. OBJECTIVE: To examine the prevalence and cost of CAM use in ALS and CAM users' profile, decision-making, information seeking, and disclosure among ALS patients. METHODS: A comprehensive literature search was conducted of MEDLINE, CINAHL/SCOPUS, and AMED databases from their inception to April 2018. This review followed PRISMA guidelines and employed a quality scoring system to assess the included papers. RESULTS: Seven papers met the inclusion criteria and were thematically analysed. ALS patients utilized a range of CAM therapies and/or products, with acupuncture and vitamins being the most frequently reported. CAM modalities were often employed concurrently with conventional medications throughout the disease process. Although some ALS patients reported positive experience regarding CAM use, many were reluctant to disclose their CAM use to their clinicians. Research focusing on CAM use in ALS remains ad hoc and restricted to only a few countries. The rigour and quality of this research field to date has been varied, predominantly drawing upon regional/localized data and failing to report CAM users' characteristics. CONCLUSION: A proportion of ALS patients report utilizing CAM concurrently with conventional treatments. Such use, set amidst a dearth of evidence for the efficacy of CAM in ALS, poses potential direct and indirect risks to patient care, and medical providers should be mindful of and enquire about CAM use when treating ALS patients.

Prevalence and profile of Australian chiropractors treating athletes or sports people: A cross-sectional study.

OBJECTIVES: A range of health-care professionals including chiropractors provide treatment for sports-related health problems. This study reports analyses from the first national workforce survey to determine practitioner and practice-related factors associated with the frequent treatment of athletes or sports people by Australian chiropractors. DESIGN AND SETTING: A 21-item questionnaire collecting information pertaining to practitioner and practice-related characteristics was distributed to all Australian registered chiropractors, as part of the Australian Chiropractic Research Network (ACORN) project and attracted a response rate of 43% (n = 2005). Statistical analyses compared the frequency of treating athletes or sports people against a wide range of relevant practitioner and practice characteristics. RESULTS: Of the respondents, 49.5% (n = 936) reported frequently treating athletes or sports people, and these chiropractors were more likely to be male as well as report more patient care hours and patient visits per week than those chiropractors who did not frequently treat athletes or sports people. Chiropractors who frequently treat athletes or sports people were also more likely to perform multi-modal management, have multi-disciplinary practitioner relations, use diagnostic equipment and discuss nutrition and medication use as part of their patient care than those chiropractors who did not frequently treat athletes or sports people. CONCLUSIONS: Nearly half of participating Australian chiropractors treat athletes or sports people frequently. The current and potential role of chiropractors in sports medicine appears significant. Further research is needed to examine the role, practices and outcomes of such chiropractic care helping to, provide treatment and policy development in this area of clinical management.