Associations between complementary medicine utilisation and the use of contraceptive methods: Results of a national cross-sectional survey.

BACKGROUND AND PURPOSE: This study examines the relationship between the use of complementary medicine (CM) interventions or consultations with CM practitioners and women's choice of contraceptive method. MATERIALS AND METHODS: A secondary analysis of a cross-sectional survey of Australian Women aged 34-39 years from the Australian Longitudinal Study on Women's Health (ALSWH) was conducted. Associations between use of CM and contraception were analysed using Chi-squared tests and multivariate logistic regression. RESULTS: Based on the responses from the included women (n = 7299), women who consulted a naturopath/herbalist were less likely to use implant contraceptives (OR 0.56; 95% confidence interval (CI) 0.33; 0.95). Those consulting a chiropractor (OR 1.54; 95%CI 1.05; 2.25) or an osteopath (OR 2.16; 95% CI 1.32; 3.54) were more likely to use natural contraception. CONCLUSION: There may be a link between women's choice of contraceptive method and their use of CM, in particular, with CM practitioner consultations.

Complementary and alternative medicine use for constipation: a critical review focusing upon prevalence, type, cost, and users' profile, perception and motivations.

OBJECTIVES: Complementary and alternative medicine (CAM) is increasingly used by those suffering from constipation. This paper reports the first critical integrative review of CAM use for people with constipation focusing upon the prevalence, type and cost of CAM use, as well as CAM users' profile, perception and motivations. METHODS: A comprehensive search of international literature was conducted in MEDLINE, Academic Search Complete (EBSCO), and Allied and Complementary Medicine Database (AMED). The search was limited to original research peer-reviewed English language articles concerning CAM use for constipation published with an abstract and full text between 2005 and 2015. RESULTS: A total of 35 papers met the inclusion criteria and were included in the review. The review shows approximately one in every three people suffering from constipation use CAM with herbal medicine the most commonly used CAM treatment for constipation and a large proportion of CAM use occurring concurrent with or in addition to conventional medical treatments. While early investigation suggests the cost of herbal medicine use in constipation care may be lower than that associated with the use other CAM modalities and conventional medications, this issue requires further research. CONCLUSIONS: Although a high percentage of people with constipation using CAM consider these treatments effective, there remains a need for further in-depth examination of both patient and provider perspectives as well as communication and decision-making around CAM use for constipation to inform safe, effective and coordinated care for patients with constipation.

Prevalence of Glucosamine and Omega-3 Fatty Acid Use and Characteristics of Users among Mid-Age Women: Analysis of a Nationally Representative Sample of 10,638 Women.

BACKGROUND: There has been a dramatic increase in the use of dietary supplements over the last few decades and both omega-3 fatty acids and glucosamine are two of the best-selling dietary supplements in many countries. An understanding of omega-3 fatty acids and glucosamine consumption is of significance to health care providers and for future health promotion activities. METHODS: This research involved analysis of data collected from a nationally-representative sample of Australian women as part of the Australian Longitudinal Study on Women's Health (ALSWH). Participants' use of omega-3 fatty acids (FA), glucosamine, their demographics, health status and health care utilisation were measured. Analysis included logistic regression modelling. RESULTS: Of the 10,638 women in the study, 26.8% reported use of omega-3 FA and 15.9% glucosamine. Women with osteoarthritis (OR=2.529; 95% CI: 2.190, 2.921), other arthritis (OR= 1.618; 95% CI: 1.375, 1.905), and joint pain (OR= 2.699; 95% CI: 2.305, 3.160) were more likely to use glucosamine (all p<0.001). In contrast, those with diabetes (OR= 0.471; 95% CI: 0.343, 0.646) or depression (OR= 0.764; 95% CI: 0.657, 0.887) were less likely to use glucosamine (both p<0.001). Women with osteoarthritis (OR=1.481; 95% CI: 1.297, 1.691) and joint pain (OR= 1.456; 95% CI: 1.306, 1.622) were more likely to use omega-3 FA (all p<0.001). CONCLUSIONS: Substantial prevalence rates for use of glucosamine and omega-3 FA amongst mid-aged women highlights the need for health practitioners and policymakers to be mindful of the possible significant role of such supplement use as part of patient health-seeking behaviours.

The characteristics of women who use hypnotherapy for intrapartum pain management: Preliminary insights from a nationally-representative sample of Australian women.

OBJECTIVES: This manuscript presents a preliminary examination of the characteristics of women who choose intrapartum hypnosis for pain management. DESIGN: Cross-sectional analysis of 2445 women (31-36 years) from a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH), employing Fisher exact tests. SETTING: Australia. MAIN OUTCOME MEASURES: Use of intrapartum hypnosis, or hypnobirthing, for pain management during labour and birth. RESULTS: Women using hypnobirthing were more likely to have consulted with an acupuncturist or naturopath, or attended yoga/meditation classes during pregnancy (p<0.0001). Use of CM products such as herbal medicines, aromatherapy oils, homoeopathy, herbal teas or flower essences (p<0.001) was also more common amongst these women. Women choosing hypnotherapy for intrapartum pain management less commonly identified as feeling safer knowing that an obstetrician is providing their care (p<0.001), and were more likely to labour in a birth centre or in a community centre (i.e. at home). CONCLUSIONS: This analysis provides preliminary analysis into an as yet unexamined topic in contemporary maternity health service utilisation. The findings from this analysis may be useful for maternity health professionals and policy makers when responding to the needs of women choosing to use hypnotherapy for intrapartum pain management.

Hypertension: What are the self-care and health-care-seeking behaviours in women over time?

The aim of this study was to estimate the prevalence and incidence of hypertension in women, and describe their self-care and health-seeking behaviours. This research was conducted as part of the Australian Longitudinal Study on Women's Health, a study comprising a nationally representative sample of Australian women in three age groups. The focus of this research is 14 099 women born in 1946-1951, who have been surveyed six times (1996-2010). Student t-tests were used to compare women who did or did not have hypertension by their health-care utilization. Longitudinal analyses were conducted using a Poisson generalized estimating equation model. The incidence of hypertension among this cohort during 1996 to 2010 ranged from 400 to 597 participants per survey, resulting in an increase in prevalence of hypertension from 20.9% in 1996 to 41.3% in 2010. For all survey periods, women with hypertension had a significantly higher average number of visits to doctors and allied health practitioners compared with women without hypertension (P<0.005). The use of complementary medicine (practitioners and self-prescribed treatments) by women with hypertension was significantly lower compared to women without hypertension (P<0.005). Over time, conventional health-care utilization was higher for women with hypertension compared with women without hypertension (adjusted RR=1.18; 95% CI: 1.14, 1.22; P<0.0001). Our findings show that women with hypertension are using a range of conventional and complementary and alternative medicine: with hypertensive women using more conventional medicine and less complementary and alternative medicine than non-hypertensive women. As such, health-care providers should communicate with their patients regarding their use of complementary and alternative medicine in their efforts to provide safe, effective and coordinate care.

Women's attitudes towards the use of complementary and alternative medicine products during pregnancy.

The aim of this study was to analyse women's attitudes towards the use of complementary and alternative medicine (CAM) products during pregnancy. The study sample was obtained via the Australian Longitudinal Study on Women's Health or ALSWH. A response rate of 79.2% (n = 1,835) was attained. Women who use herbal medicines (34.5%, n = 588) view CAM as a preventative measure, are looking for something holistic and are concerned about evidence of clinical efficacy when considering the use of these products during pregnancy. Women who use aromatherapy (17.4%, n = 319) and homoeopathy (13.3%, n = 244) want more personal control over their body and are concerned more about their own personal experience of the efficacy of CAM than clinical evidence of efficacy. As CAM use in pregnancy appears to be increasingly commonplace, insights into women's attitudes towards CAM are valuable for maternity healthcare providers.

Association between consultations with complementary/alternative medicine practitioners and menopause-related symptoms: a cross-sectional study.

OBJECTIVES: To examine the associations between consultations with complementary and alternative medicine (CAM) practitioners and menopause-related symptoms. METHODS: A cross-sectional survey of a nationally representative sample of 10 011 women aged 59-64 years from the Australian Longitudinal Study on Women's Health, conducted in 2010. Women, including those with hysterectomy, oophorectomy and natural menopause, were asked about their consultations with a range of CAM practitioners and menopause-related symptoms experienced. RESULTS: Acupuncturists were more likely to be consulted by women with hysterectomy experiencing night sweats (odds ratio, OR = 2.21), but were less likely to be consulted by those experiencing hot flushes (OR = 0.53). Acupuncturists were also more likely to be consulted by women with oophorectomy (OR = 3.11) and natural menopausal women (OR = 1.57) experiencing back pain. Massage therapists were more likely to be consulted by women with oophorectomy experiencing back pain (OR = 1.98), women with hysterectomy experiencing anxiety (OR = 1.52), and natural menopausal women experiencing back pain (OR = 1.54) and/or anxiety (OR = 1.29). Naturopaths/herbalists were more likely to be consulted by women with oophorectomy experiencing leaking urine (OR = 2.08). Chiropractors/osteopaths were more likely to be consulted by women across all menopausal status experiencing back pain (OR = 2.52, 2.31 and 2.25 for women with oophorectomy, hysterectomy and natural menopause, respectively). CONCLUSIONS: There are substantial levels of CAM practitioners' consultations amongst menopausal women, with a range of menopause-related symptoms associated with the use of specific CAM practitioner modalities. It is important that health-care providers are mindful of CAM practitioner use in order to ensure safe, effective and coordinated treatment and support for menopausal women in their care.

A critical review of traditional Chinese medicine use amongst women with menopausal symptoms.

OBJECTIVES: To provide the first critical review of traditional Chinese medicine (TCM) use amongst symptomatic menopausal women, drawing upon work examining the perspectives of both TCM users and TCM practitioners. METHODS: A search was conducted in three English-language databases (MEDLINE, CINAHL and AMED) and three Chinese-language databases (CNKI, VIP and CBM Disc) for 2002-2013 international peer-reviewed articles reporting empirical findings of TCM use in menopause. RESULTS: A total of 25 journal articles reporting 22 studies were identified as meeting the review inclusion criteria. Chinese herbal medicine appears to be the most common therapy amongst symptomatic menopausal women, and vasomotor symptoms and emotional changes are the most frequent symptoms for which TCM is sought. However, evidence regarding the prevalence of TCM use and users' profile in menopause is limited. Existing studies are of varied methodological quality, often reporting low response rate, extensive recall bias and a lack of syndrome differentiation. CONCLUSIONS: This review provides insights for practitioners and health policy-makers regarding TCM care to symptomatic menopausal women. More nationally representative studies are required to rigorously examine TCM use for the management of menopausal symptoms. Syndrome differentiation of menopausal women is an area which also warrants further attention.

Homeopathy in rural Australian primary health care: a survey of general practitioner referral and practice in rural and regional New South Wales, Australia.

INTRODUCTION: Homeopathy has attracted considerable recent attention from the Australian conventional medical community. However, despite such increased attention there has been little exploration of the interface between homeopathy and Australian conventional medical practice. This article addresses this research gap by exploring homeopathic practice and referral by rural and regional Australian general practitioners (GPs). MATERIALS AND METHODS: A 27-item questionnaire was sent to all 1486 GPs currently practising in rural and regional New South Wales, Australia (response rate 40.7%). RESULTS: Few GPs in this study utilised homeopathy in their personal practice, with only 0.5% of GPs prescribing homeopathy in the past 12 months, and 8.5% referring patients for homeopathic treatment at least a few times over the past 12 months. Nearly two-thirds of GPs (63.9%) reported that they would not refer for homeopathy under any circumstances. Being in a remote location, receiving patient requests for homeopathy, observing positive responses from homeopathy previously, using complementary and alternative medicine (CAM) practitioners as information sources, higher levels of knowledge of homeopathy, and being interested in increasing CAM knowledge were all independently predictive of increased referral to homeopathy amongst GPs in this study. GPs in this study were less likely to refer to homeopathy if they used peer-reviewed literature as the major source of their information on CAM. CONCLUSIONS: Homeopathy is not integrated significantly in rural general practice either via GP utilisation or referral. There is significant opposition to homeopathy referral amongst rural and regional GPs, though some level of interaction with homeopathic providers exists.

Evaluating the impact of cancer on complementary and alternative medicine use, distress and health related QoL among Australian women: a prospective longitudinal investigation.

OBJECTIVES: While several cross-sectional studies have examined psychological correlates of complementary and alternative medicine (CAM) use and cancer, few prospective longitudinal investigations have been reported. This study examined whether CAM use moderated distress and quality of life (HRQoL) from pre- to post-cancer. DESIGN: A prospective longitudinal national cohort design. SETTING: Participants were 718 mid-aged women from the Australian longitudinal study on women's health who did not have cancer at survey 1, but who subsequently developed cancer. For each participant, three waves of data were extracted: the wave prior to diagnosis ('pre'), at diagnosis ('cancer'), and after cancer ('post'). MAIN OUTCOME MEASURES: CAM use was measured by the question 'in the past 12 months have you consulted an alternative health practitioner'. Distress was measured by perceived stress (PSS) and depression (CES-D 10), HRQoL was measured by physical and mental health functioning (SF-36). RESULTS: CAM use significantly moderated the change over time in stress [F(561)=3.09, p=0.04], depression [F(494)=3.14, p=0.04], but not HRQoL. CAM-users were significantly more stressed than non-users pre-cancer (p<0.05), but there were no significant differences at subsequent surveys. CAM-users were significantly less depressed post-cancer compared to non-users (p<0.05). CONCLUSIONS: Findings indicated that CAM users may be more psychologically vulnerable than non-users with respect to stress, with CAM acting as an effective psychological, but not HRQoL, intervention.

The use of traditional, complementary and alternative medicine in Sri Lankan cancer care: results from a survey of 500 cancer patients.

OBJECTIVES: While the introduction of biomedicine within the Sri Lankan healthcare system has resulted in reduced reliance on traditional, complementary and alternative medicine (TCAM) over the last century in Sri Lanka, treatment modalities such as Ayurveda, Sinhala and traditional religious practices still receive considerable public support. Cancer is an increasing burden in Sri Lanka, and whilst Sri Lankans are known to use TCAM for everyday ailments, there has been no research examining the role of TCAM in the context of cancer. The aim of this study was to evaluate the prevalence and patterns of TCAM use by cancer patients. STUDY DESIGN: Cross-sectional survey. METHODS: Data were obtained from two Sri Lankan hospitals using a consecutive convenience sample of 500 cancer patients currently receiving biomedical treatment, over a 10-week period in 2008. RESULTS: Analyses showed that 67.4% of those surveyed used one or more TCAM in conjunction with biomedicine for cancer treatment. The most common were Sinhala, Ayurveda and traditional religious practices. Of those patients who used TCAM, 95.0% gave the main reason for usage as 'they thought it would cure their cancer'. The strongest reason for not using TCAM was on advice from their doctor (80.5%). CONCLUSIONS: The high use of TCAM amongst cancer patients in Sri Lanka raises numerous important issues, including those related to patient safety, potential benefit, interactions with biomedical cancer treatments, and delays in seeking biomedical cancer care. Further research is needed to explore the decision-making processes of cancer patients, including the perceived benefits/limitations of key processes in biomedical and TCAM care.

Complementary and alternative medicine practitioner consultations among those who have or have had cancer in a Norwegian total population (Nord-Trøndelag Health Study): prevalence, socio-demographics and health perceptions.

The aim of the study was to identify the use of complementary and alternative medicine (CAM) practitioners among current and previous cancer patients in a total population. A secondary analysis of data from the Nord-Trøndelag Health Study (otherwise known as the HUNT 2 Study) - a total population survey conducted in central Norway - was undertaken. Analysis focused upon the response of 1406 individuals who reported to have or have had cancer and who answered a question on visits to CAM practitioners. The study identified 16.1% of respondents had visited a CAM practitioner in the prior 12 months compared with 12.8% in the total population, and the likelihood of consulting a CAM practitioner was significantly increased among those who had a university degree, who reported a lower perceived global health and who had experienced a health complaint during the last 12 months. Complementary and alternative medicine practitioner consultations among individuals with a previous or current malignant disease were highest for those with poor self-reported health status and with a recent health complaint. From the socio-demographic variables studied only the reporting of a university degree was significantly associated with higher CAM practitioner use.

An examination of the prescription and dispensing of medicines by Western herbal therapists: a national survey in Australia.

OBJECTIVE: To describe the patterns of prescription and dispensing of herbal medicines employed by Western herbal practitioners in Australia. DESIGN: A national postal survey sent to all full members of the National Herbalist Association of Australia (NHAA). SETTING: Nationwide clinics of professional herbal practitioners in Australia. MAIN OUTCOME MEASURES: Measures of medicinal use were collected including aspects of prescription, formulation, dispensing and preparation forms of medicines used. The practitioners were asked if they dispensed their own medicines, about the form of herbal preparations used, aspects of formulation and dosages. RESULTS: The predominant prescription by most Western herbal practitioners in Australia is individualised herbal formulae rather than the use of single herbs. Traditional preparations of herbals such as teas and powders are used but liquid herbal extracts are most commonly dispensed. These liquid medicines are in the form of highly concentrated fluid extracts in ratios of 1:1 or 1:2, herb material to liquid. Pre-formulated tablets or capsules made by herbal manufacturers are being incorporated into modern practice but most prescriptions are individualised liquid formulae prepared and dispensed, from the clinic dispensary, after patient consultation. In addition to internal prescriptions, topical creams, pessaries, douches, gargles, eyebaths and poultices or washes are still incorporated into treatments. Although there is variation in used dosage ranges, the predominant system is that of pharmacologically active doses of highly concentrated fluid extracts. CONCLUSION: The professional prescription of Western herbal medicines is different to commercial usage. As opposed to pre-formulated tablets, or use of single herbals, the vast majority of Western herbalists in Australia construct individualised herbal formulations for their patients after consultation. The preferred form of administration of these prescriptions is as highly concentrated liquid herbal extracts in pharmacologically active doses.

Naturopathy/herbalism consultations by mid-aged Australian women who have cancer.

Complementary and alternative medicine (CAM) is now a significant practice issue for those delivering cancer care with a range of CAM being utilized by a significant number of patients with cancer. While various studies have explored the prevalence of CAM use among cancer patients, little is currently known about naturopathy/herbalism use by patients with cancer in Australia. This paper reports the prevalence of naturopath/herbalist consultations among mid-aged Australian women with cancer. The research was conducted as part of the Australian Longitudinal Study on Women's Health, with the data for this analysis coming from the third survey of 11,202 women aged 50-55, conducted in 2001. For all cancers combined, 15.7% of women with cancer were found to consult a naturopath/herbalist. Mid-aged women with cancer were found to be more likely to consult a naturopath/herbalist than mid-aged women without cancer. Naturopathy/herbalism consultations appear to be utilized by the women with cancer alongside and as a supplement to conventional health services. Given the prevalence of consultations with herbal therapists/naturopaths among mid-aged women with cancer in Australia, it is important that physicians and others involved in cancer patient care and management are informed and educated about naturopathy/herbalism and its use among their patients.

The use of acupuncture in maternity care: a pilot study evaluating the acupuncture service in an Australian hospital antenatal clinic.

This paper outlines an exploratory study charting the circumstances of use and patient perspectives regarding the acupuncture service offered in an antenatal clinic at an Australian public hospital. Study participants were recruited from women attending the antenatal clinic. Upon completion of their course of acupuncture treatment, 52 women were given a questionnaire, of which 37 (71%) were completed and returned. Of the 37 women who attended the acupuncture clinic, 18 (49%) had previously used at least one form of complementary medicine/therapy. The most common reason for treatment was physiological symptoms including back pain, symphysis pubis dysfunction and sciatica. All 37 women stated that the acupuncture improved their well-being and this finding was statistically significant (P<0.001). These findings are offered as a means of identifying potential issues for future investigation in this under-researched area.

Exploring the relationship between women's health and the use of complementary and alternative medicine.

In this paper we identify the need for further research exploring the relationship between complementary and alternative medicine (CAM) use and women's health. We offer our personal thoughts on the direction such future research might take outlining a number of research domains (type of CAM consumption, longitudinal analysis of women's use of CAM, cross-cultural analysis of women's CAM consumption, reasons for women's CAM consumption). We hope that this brief paper helps inspire greater research attention upon what we believe to be a well deserving sub-field of study within the social science of CAM.