Profile of Australian Yoga Providers: Results from the Practitioner Research and Collaboration Initiative (PRACI) Workforce Survey.

Yoga is becoming increasingly popular in Western countries, particularly for maintaining health and managing chronic noncommunicable diseases. Yoga providers, including yoga teachers, yoga therapists, and healthcare workers using yoga in clinical practice, are vital in facilitating group and personalized yoga sessions. This article aims to meet an unmet need to profile the sociodemographic and practice characteristics of yoga providers in Australia. A workforce survey was distributed electronically to yoga providers throughout Australia via the Practitioner Research and Collaboration Initiative (PRACI). The yoga providers' sociodemographic and practice characteristics, professional qualifications, and practice interests reported in the survey were analyzed. The study reveals a predominantly female, middle-aged, and tertiary-educated workforce. The yoga providers considered themselves group educators offering complementary and integrative health services. Typically, they had worked part-time as a solo provider for more than 10 years since acquiring their first yoga qualification. This study represents the first exploration of the Australian yoga provider workforce on a national level. It suggests that some Australian yoga providers are highly qualified professionals integrating with healthcare modalities in education and practice. The landscape of yoga providers in Australia needs further investigation.

Criteria for the selection, evaluation and application of traditional knowledge in contemporary health practice, education, research and policy: A systematic review.

BACKGROUND: Traditional and complementary medicine (T&CM) is highly utilised and draws on traditional knowledge (TK) as evidence, raising a need to explore how TK is currently used. OBJECTIVES: Examine criteria used to select, evaluate and apply TK in contemporary health contexts. METHODS: Systematic search utilising academic databases (AMED, CINAHL, MEDLINE, EMBASE, SSCI, ProQuest Dissertations Theses Global), Trip clinical database and Google search engine. Citations and reference lists of included articles were searched. Reported use of TK in contemporary settings was mapped against a modified 'Exploration-Preparation-Implementation-Sustainment' (EPIS) implementation framework. RESULTS: From the 54 included articles, EPIS mapping found TK is primarily used in the Exploration phase of implementation (n = 54), with little reporting on Preparation (n = 16), Implementation process (n = 6) or Sustainment (n = 4) of TK implementation. Criteria used in selection, evaluation and application of TK commonly involved validation with other scientific/traditional evidence sources, or assessment of factors influencing knowledge translation. DISCUSSION: One of the difficulties in validation of TK (as a co-opted treatment) against other evidence sources is comparing like with like as TK often takes a holistic approach. This complicates further planning and evaluation of implementation. CONCLUSION: This review identifies important criteria for evaluating current and potential contemporary use of TK, identifying gaps in research and practice for finding, appraising and applying relevant TK studies for clinical care.

Patient-shared knowledge and information in clinical decision-making: an international survey of the perspectives and experiences of naturopathic practitioners.

INTRODUCTION: Most knowledge translation models pay relatively little attention to patient-held knowledge and are largely based on the premise that researchers and clinicians hold all valuable knowledge, and patients are passive recipients of such knowledge. Counter to this clinician- and researcher-centred lens is a growing interest and awareness of patients as experts in their health. While naturopathic medicine is described and experienced as a patient-centred system of traditional medicine, the position of patient-held knowledge is unclear particularly when considered alongside their use of other more objective forms of knowledge such as research evidence. METHODS: This international online cross-sectional survey aimed to explore naturopathic practitioners' perceptions of the value and contribution of patient-shared knowledge and information within the context of naturopathic clinical consultations. RESULTS: The survey was completed by 453 naturopathic practitioners (response rate: 74.3%). Approximately two-thirds (68.2%) of respondents reported using information shared by the patient. Most rated 'information provided by the patient' as either 'extremely important' (60.7%) or 'very important' (31.4%) to patients. Highest levels of trust were reported for information provided by the patient ('completely': 9.9%; 'a lot': 53.6%). Most practitioners indicated they trusted knowledge and information derived from the patient's personal health history 'completely' (n = 79; 21.8%) or 'a lot' (n = 226; 62.4%) from the patient's perspective of living with a health condition ('completely' [n = 63, 17.4%]; 'a lot' [n = 224, 61.9%]). Patients were the highest ranked stakeholder group (mean: 1.5) perceived to influence NP use of patient experience of living with a health condition to inform clinical decision-making. CONCLUSION: Researchers and policy makers are increasingly focused on the value of the 'expert patient' in clinical decision-making, yet health professionals' report challenges and, in some cases, resistance to meaningfully engaging with patient-shared knowledge in practice. However, our study has found patient-shared knowledge - inclusive of patient experience of their health condition - is among the knowledge used and trusted by naturopathic practitioners to inform their clinical decision-making. This study both offers insights into the knowledge translation behaviours of an under-researched health profession and provides a novel contribution to the wider aim of adopting patient-shared knowledge into clinical care more generally.

Variations in folate prescriptions for patients with the MTHFR genetic polymorphisms: A case series study.

Background: Over 48.5 million couples are reported with infertility worldwide. Health policy recommends folic acid in women of childbearing age, particularly in preconception and pregnancy which results in women purchasing over-the-counter prenatal multivitamins containing folic acid through pharmacies and other retail outlets. Emerging studies are investigating whether other forms of supplemental folate are more suitable, particularly for those with methylenetetrahydrofolate reductase (MTHFR) polymorphisms. This case series aimed to document variations in forms and dosage of folate prescribed by Australian practitioners to patients with diagnosed infertility and MTHFR polymorphisms. Methods: Australian practitioners were invited to complete a retrospective case report form for patients that presented with unexplained infertility. This case report form documented the form and dose of folate that practitioners were prescribing to their infertility patient with MTHFR polymorphisms, together with their fertility history. Results: Six practitioners submitted case information for 12 patients with diagnosed infertility and MTHFR polymorphisms. All patients had been advised by their practitioner to remove folic acid in supplemental form and were prescribed 5-methyltetrahydrofolate (5-MTHF) or a combination of 5-MTHF and folinic acid, at higher doses than the Australian recommended dose (mean daily maximum prescribed dose: 2325µg). Eleven patients conceived within the treatment period (average treatment of one year) and ten were reported as having a live birth. Conclusion: This case series has highlighted clinical practices that vary from the recommendations by Australian policy. Further research is required to verify the clinical importance of variations in folate prescriptions for women with MTHFR polymorphisms and how folate recommendations may need to change depending on these polymorphisms. This has direct relevance to those prescribing at the pharmacy and retail level, specifically pharmacists and pharmacy assistants.

Making sense of complexity: A qualitative 'Framework' analysis of naturopathic case management and clinical reasoning.

BACKGROUND AND PURPOSE: The clinical encounter is inherently complex and uncertain. Naturopathic clinical practice is shaped by a traditional philosophy and practice guiding principles, with a therapeutic framework that incorporates a complex inter-systems approach. It is possible that this foundation may orient naturopathic practitioners to manage clinical complexity and uncertainty in a distinct manner. The aim of this study is to explore the perceptions of experienced naturopathic practitioners to the management of clinical complexity within naturopathic care. MATERIALS AND METHODS: Twenty experienced Australian naturopathic practitioners participated across four focus groups, responding to semi-structured questions regarding their clinical reasoning strategies and case management processes. The data were analysed using a seven step Framework analysis method. RESULTS: Three primary themes were identified: i) patient is encountered as a whole entity, ii) clinical reasoning is ampliative and explicative, and iii) treatment reflects systems thinking. Participants perceived a focus on the connections between various case elements, building a comprehensive internalised schematic of each case. Participants saw treatments as meeting various needs including prevention, symptom alleviation, causal mitigation, and support of innate healing processes. CONCLUSION: Naturopathic practitioners perceive they clinically embody the traditional holistic philosophy of naturopathy as a systems orientation, incorporating traditional and contemporary bioscience knowledge. This appears to shape a distinct naturopathic case management approach, oriented to working with patients in a complexity-informed manner.

Use of Complementary and Alternative Medicine and its Related Factors Among Pregnant Women in Shiraz, South of Iran: A Cross-Sectional Study.

Background: Women are known to use Complementary and Alternative Medicine (CAM) during pregnancy despite the subsequent potential unknown effects associated with its use. This study was performed to evaluate the use of CAM products and its related factors among pregnant women in Shiraz, Iran. Materials and Methods: This cross-sectional study of 365 pregnant women referred to obstetrics clinics affiliated to Shiraz University of Medical Sciences (Iran) was conducted in 2020. Sampling was performed in all three affiliated centers based on a probability, proportional to size protocol. Pregnant women were nominated using a systematic random sampling scheme using their health record numbers. A 20-item questionnaire was administered via in-person interviews and data on demographics, use of CAM products, reasons for use, and referral and information sources were collected. Binary logistic regression was applied and adjusted odds ratios were estimated. Results: CAM use was reported for recent pregnancies by 56.92% of participating women, with a significantly higher use in participants of low socioeconomic status (Chi21 = 5.12; p < 0.024). The main reason for CAM use was having faith in the efficacy of CAM (72.73%). Reported CAM use was restricted to herbal preparations. Most of the women who used CAM (73.0%) did not report their CAM use to their doctor. Conclusions: There is a high rate of CAM use among pregnant women. More maternal care services during current pregnancy, parity, and general and pregnancy-related history of CAM use were correlated with CAM use. Mother-healthcare provider relationship should be improved in the field of CAM.

Exploring Criteria for the Translation of Traditional Knowledge Within Contemporary Clinical Practice, Research, Policy, and Education: A Stakeholder Forum.

Background: The 2018 Declaration of Astana identifies traditional knowledge (TK) as one of the drivers for strengthening primary health care systems through the use of technology (traditional medicines) and knowledge and capacity building (traditional practitioners). While TK underpins both traditional practice and the use of traditional medicines, facilitating the use of TK in contemporary health care systems has been difficult to achieve. The aim of this study was to identify key factors related to the translation of TK into contemporary settings to help establish tools to support the knowledge translation process. Methods: This study used World Café methodology to collect the observations, ideas, and perspectives of experts who use TK in their practice. These experts (n = 9) were from a variety of contexts, including clinical practice, research, education, policy, and consumer advocacy, participated in the 1-day event. Data were collected into NVivo 12 software and analyzed using inductive-deductive thematic analysis. Results: Thematic analysis identified five themes: the need to define the elements required for critical evaluation of sources of TK as evidence, the importance of applying a tradition-centric lens when translating TK for contemporary use, the need to bridge gaps between TK and its contemporary applications, the value of critically evaluating the TK translation process itself, and the recognition of traditions as living systems. Taken together, the themes showed holistic interpretation of the translation process that incorporates critical analysis of the TK itself and accountable, transparent, and ethical processes of translation that consider safety, socioeconomical and intellectual property impacts of TK in contemporary use. Conclusions: Stakeholders identified TK as a valid and important source of evidence that should guide practice in a range of contemporary settings (e.g., policy and clinical practice), and outlined important consideration for critiquing, evaluating, communicating, and using TK within these settings.

Characteristics of Marginalized Populations Seeking Acupuncture: Findings from an Observational Study of an Inner-City Community Health Service.

Introduction: Marginalized populations experience health inequities and are often underserved within existing health systems. Australian marginalized populations and their use of complementary medicine, including acupuncture, lack investigation. We have collected information on the health-seeking behaviors of marginalized individuals who utilize an acupuncture service within a community-based integrative health setting. Methods: A secondary analysis of pre-existing data involving the linking of three datasets. Information was collected across four domains: health characteristics, socio-demographics, health services utilization, and vulnerability markers. Bivariate analysis using Fisher's exact and chi-square tests additional to logistic regression analysis were conducted to determine the characteristics of the study population. All data once analyzed were then presented as a cumulative statistic. Results: Study participants (n = 42) included 28% of individuals with reported histories of homelessness (n = 12) and 32% with a history of psychological trauma (n = 13). Eighty-three percent (n = 31) of the population sought acupuncture to manage pain and 91% (n = 36) for musculoskeletal conditions. Sixty-three percent (n = 24) reported a mental health diagnosis, most commonly depression (n = 18). Participants were most likely to engage with three other health services within the study setting, in addition to acupuncture. Participants with an illicit substance abuse problem were 12 times more likely to seek a greater number of acupuncture treatments, and individuals with trauma histories were twice as likely to attend the acupuncture clinic eight or more times. Discussion: Our study findings suggest a robust level of engagement with acupuncture treatment among the target population and a willingness to engage with integrative health services when barriers to uptake such as accessibility and affordability are removed. Findings support current evidence pertaining to acupuncture's use as an adjunct to managing pain in marginalized populations as well as a perceived acceptability and feasibility of the integration of acupuncture within conventional health settings. There is the further observation that acupuncture in a group setting is suitable for a marginalized population and an interest in commitment to treatment among individuals with substance abuse problems.

The salutogenic gaze: Theorising the practitioner role in complementary and alternative medicine consultations.

Research on why people use complementary and alternative medicine (CAM) shows clients value the CAM consultation, where they feel listened to and empowered to control their own health. Such 'empowerment' through CAM use is often theorised as reflecting wider neoliberal imperatives of self-responsibility. CAM users' perspectives are well studied, but there has been little sociological analysis of interactions within the CAM consultation. Specifically, it is unclear how user empowerment/self-knowledge relates to the CAM practitioner's power and expert knowledge. We address this using audio-recorded consultations and interviews with CAM practitioners to explore knowledge use in client-practitioner interactions and its meaning for practitioners. Based on our analysis and drawing on Foucault (1973), The Birth of the Clinic: an archaeology of medical perception and Antonovsky (1979), Health, Stress and Coping, we theorise the operation of power/knowledge in the CAM practitioner-client dyad by introducing the concept of the 'salutogenic gaze'. This gaze operates in the CAM consultation with disciplining and productive effects that are oriented towards health promotion. Practitioners listen to and value clients' stories, but their gaze also incorporates surveillance and normalisation, aided by technologies that may or may not be shared with clients. Because the salutogenic gaze is ultimately transferred from practitioner to client, it empowers CAM users while simultaneously reinforcing the practitioner's power as a health expert.

Naturopathic Workforce: A Global Resource Toward the Declaration of Astana Goals-A Multimethods Study.

Introduction: The World Health Organization identified health to be the most important social goal and the 1978 Declaration of Alma Ata placed primary health care central to its attainment and the UN Sustainable Development Goals (SDGs) as the template. The Astana Declaration called on a change of focus in primary care, from treatment of specific diseases to the prevention and inclusion of both scientific and traditional knowledge. Such objectives require public-private partnerships in providing health care, including traditional and complementary medicine systems such as naturopathy that align. However, there is limited understanding of global regulatory frameworks and officially recognized training for naturopathy. Materials and Methods: This descriptive study employs an adapted mixed-methods explanatory framework to examine naturopathy regulation and education. Analysis merges data arising from a descriptive policy analysis of regulation from 36 countries and survey analysis from 65 naturopathic organizations from 29 countries. Results: Four types of workforce regulation were identified within 107 countries where naturopathy was practiced-statutory registration or occupational licensing, coregulation, negative licensing, and voluntary certification. No form of naturopathic regulation was most common. Higher graduate/postgraduate education and access to a broader range of practices were more frequently reported in countries where naturopathy is statutory regulated. Government audits were more frequently reported where naturopathy was statutory regulated or coregulated. Discussion: Naturopathic philosophy and practice align with primary health care goals outlined in the Declaration of Astana. The naturopathic workforce represents an untapped health care resource with a demonstrated track record of translating these aspirational goals into practice. However, naturopathy remains inconsistently regulated globally, serving as a significant barrier to partnering with other health system actors to attain the health-related SDGs. Workforce regulation for the naturopathic profession offers increased standards, reduced risks, integrative health workforce planning, and assistance to countries toward achieving the promise of the Declaration of Astana.

Osteopathy in rural and remote Australia: analysis of demographic, practice and clinical management characteristics from a nationally representative sample of 992 osteopaths.

INTRODUCTION: There is significant interest in allied health and the role it plays in health care for rural and remote populations. In Australia, osteopaths are allied health professionals who manage predominantly musculoskeletal complaints using manual therapy, exercise and patient education. Workforce distribution is a significant issue for osteopathy in Australia with most practitioners centred in the metropolitan regions of Victoria and New South Wales. There is limited evidence about the role osteopathy plays in the musculoskeletal health of Australian rural and remote populations. This research sought to profile the characteristics of Australian osteopaths who practise in rural and remote settings. METHODS: A secondary analysis of the Osteopathy Research and Innovation Network (ORION) data was undertaken to identify the demographic, practice and clinical management characteristics of Australian osteopaths in rural and remote settings. ORION is a practice-based research network for the Australian osteopathy profession. The ORION questionnaire comprised 27 items regarding osteopaths' characteristics. Inferential statistics were used to identify characteristics that were significantly different between Australian osteopaths practising in rural and remote settings compared to those practising in urban settings. Logistic regression was used to calculate adjusted odds ratios (AOR) relating to characteristics significantly associated with practising in a rural and remote setting. RESULTS: Of 992 osteopaths who responded to the ORION questionnaire, 18.3% (n=172) indicated practising in a rural and remote setting. Australian osteopaths in rural and remote settings were more likely to report receiving referrals from massage therapists (AOR 2.17), send referrals to other osteopaths (AOR 1.64), and often treat patients over the age of 65 years (AOR 2.25) compared to their urban counterparts. Osteopaths in rural and remote setting were less likely to report using private health insurance claim systems (AOR 0.36) and to treat non-English-speaking patients (AOR 0.09). CONCLUSION: This secondary analysis identified several practitioner and practice characteristics that differ between osteopaths practising in rural and remote settings and those practising in urban settings. These findings contribute to the emerging picture of the practice of rural and remote Australian osteopaths. Further research is required to understand the role osteopaths play in rural and remote health care, and how the current data can inform workforce and health policy development.

Providing naturopathic care in the community: Perspectives of recent naturopathy graduates in Australia.

BACKGROUND AND PURPOSE: Naturopathy is a traditional medicine system originating from Europe and naturopathic practitioners provide care to 6.2% of Australians in a 12-month period. Australian naturopathic programs have undertaken a slow transition over the last 20 years from Advanced diploma to Bachelor degree as the minimum level of qualification for entry into the profession. This study aimed to understand and describe the experience of naturopathic graduates completing Bachelor degree and transitioning to provide naturopathic care in the community. MATERIALS AND METHODS: Qualitative semi-structured phone interviews were conducted with graduates of Bachelor's degree naturopathy programs, within five years of completing their studies. The data were analysed using Framework analysis methods. RESULTS: The analysis identified three related themes: (1) Love for looking after patients, but clinical practice is not easy, (2) Finding a place in the naturopathic profession and in the health system; and (3) Protecting the future of the profession and practice through registration. CONCLUSION: Graduates of Australian Bachelor's degree naturopathic programs face challenges as they attempt to find a place within their professional community. By identifying these challenges the profession's leaders may be able to develop initiatives to better support graduates and increase the success of new naturopaths.

Prevalence and Characteristics of Australians Complementary Medicine Product Use, and Concurrent Use with Prescription and Over-the-Counter Medications-A Cross Sectional Study.

Data about the characteristics and prevalence of complementary medicine (CM) product use by Australians, including concurrent use with prescription and over-the-counter medications, have not been collected in the last five years. A cross-sectional online survey involving a representative sample of the Australian population was administered in 2021-2022. Of the 2351 survey responses included in this study, 49.4% reported use of a CM product over the previous 12-month period. Of these, 50% reported they always or often used CM products on the same day as a prescription medicine. Participants aged 65 and over were five times more likely to use CMs and other medications on the same day compared to 18-24-year-olds. Lower levels of education and having a chronic illness were also predictors of same-day use. The prevalence and characteristics of CM use by participants was similar to data collected five years ago. The study shows that concurrent use of CM products with prescription medications among older and more vulnerable populations is prevalent and this area requires further research to help ensure appropriate and safe use of CM products.

The converging paradigms of holism and complexity: An exploration of naturopathic clinical case management using complexity science principles.

RATIONALE: Traditional whole systems of medicine, such as naturopathy, are founded upon holism; a philosophical paradigm consistent with contemporary complexity science. Naturopathic case management is predicated upon the understanding of an intimately interconnected internal physiological and external context of the human organism-potentially indicating a worldview aligned with a complexity perspective. In this study we investigate naturopathic clinical reasoning using a complexity lens with the aim of ascertaining the extent of correspondence between the two. METHOD: Mind maps depicting case presentations were sought from Australian degree qualified naturopaths. A network mapping was undertaken, which was then analysed in accordance with a complexity science framework using exploratory data analysis and network analysis processes and tools. RESULTS: Naturopathic case schematics, in the form of mind maps (n = 70), were collected, network mapped, and analysed. A total of 739 unique elements and 2724 links were identified across the network. Integral elements across the network were: stress, fatigue, general anxiety, systemic inflammation, gut dysbiosis, and diet. A modularity algorithm detected 11 communities, the primary ones of these representing the nervous system and mood; the gastrointestinal tract, liver, and nutrition; immune function and the immune system; and diet and nutrients. CONCLUSIONS: Naturopathic case management is holistic and based on a perspective of an integrated physiology and external context of the human organism. The traditional concept of holism, when subjected to a complexity lens, leads to the emergence of a contemporary holistic paradigm cognisant of the human organism being a complex system. The application of complexity science to investigate naturopathic case management as employed in this study, demonstrates that it is possible to investigate traditional philosophies and principles in a scientific and critical manner. A complexity science research approach may offer a suitable scientific paradigm to develop our understanding of traditional whole systems of medicine.

Naturopathic knowledge and approaches to managing endometriosis: a cross-sectional survey of naturopaths with experience in endometriosis care.

OBJECTIVES: Endometriosis is a chronic gynaecological disease with varying symptomatology and negative health outcomes. To ensure the best care for women with endometriosis, women require a multidisciplinary team approach. While some women consult with naturopaths for endometriosis, there has been little research on naturopathic knowledge and the naturopathic approach to endometriosis care. METHODS: This cross-sectional survey recruited naturopaths with experience in menstrual disorders from the Practitioner Research and Collaboration Initiative (PRACI) a Practice-Based Research Network (PBRN). Data collection was conducted via an online self-administrated 62-item questionnaire. RESULTS: Invitations were sent to 109 naturopaths who self-reported having experience in menstrual disorders, of whom 29 completed the survey (26.6% response rate). Naturopaths perceived endometriosis to be caused by inflammation (n=28, 96.5%) and risk factors associated with familial history (n=26, 89.6%). Many naturopaths aimed at reducing inflammation (n=27, 93.1%) and supporting gastrointestinal function (n=25, 86.2%) in their prescriptions. Naturopaths reported using various healthcare referrals to support women with endometriosis, primarily general practitioners (n=12, 41.3%), acupuncturists/Traditional Chinese Medicine practitioners (n=11, 37.9%), and gynaecologists (n=9, 31%). Naturopaths reported receiving referrals from general practitioners (n=8, 27.5%) and psychologists (n=6, 20.6%). CONCLUSIONS: Naturopathic knowledge and management of endometriosis targets known problematic areas of endometriosis that can have debilitating effects on women's quality of life. Naturopathic care has the potential to align with important health outcomes for women with endometriosis however, further attention is needed to assess the effectiveness and continue to establish a multidisciplinary approach involving naturopathic care.

Prevalence and predictors of naturopathic practitioners' self-reported practice behaviours: results of an international survey.

Background: The naturopathic workforce spans over 108 countries and is estimated to provide care to over 5.5 million patients globally per month. Despite such demand, naturopathic practitioners are not well integrated into mainstream health systems, in part due to poor knowledge about naturopathy among policy makers and other health professionals. This study aims to describe naturopathic practitioners' practice behaviours and examine the characteristics that predict the use of naturopathic treatments and practices around the world. Methods: An international cross-sectional online survey was distributed through World Naturopathic Federation membership organisations and social media accounts. Multivariate reverse stepwise logistic regression was undertaken to examine potential predictors of practice behaviours, adjusting for the influence of demographic and practice characteristics. Results: A response rate of 78.4% was achieved (n=478). Lifestyle modifications, dietary changes, nutritional products and herbal medicines were most consistently prescribed Always or Most of the time. At least one-half of participants discussed nine of the ten health topics during clinical practice Always or Most of the time. More than one-half (55.1%) of participants practiced in a location with statutory regulation/occupational certification. Compared to participants located in countries with voluntary certification/no regulation, those in countries with statutory registration/occupational licensing had higher odds of prescribing nutritional products (adjusted odds ratio (aOR)=2.5) or IV/injection therapies (aOR=18.4). Conclusion: The findings of this study provide important insights into contemporary naturopathic practice behaviour, which may help to overcome misconceptions about such practice among other health professionals, policy makers and the community.

Classifying knowledge used in complementary medicine consultations: a qualitative systematic review.

BACKGROUND: Complementary Medicine (CM) is widely used internationally but there is limited understanding of the forms of knowledge CM practitioners use in their clinical practice and how they use this knowledge in interactions with patients. This review aims to synthesise the existing evidence on the forms of knowledge that are mobilised, and the role of this knowledge in the interactions between practitioners and patients during CM consultations. It considered a diverse range of CM practice areas to develop a classification of CM practitioners' knowledge use in consultations. METHODS: Systematic searches of health and sociology databases were conducted using core concepts, including complementary and alternative medicine, practitioners, and knowledge. Articles were included where they reported on data from recorded CM practitioner and patient consultations and offered insights into the types and applications of knowledge used in these consultations. 16 unique studies were included in the review. Data were extracted, coded and analysed thematically. RESULTS: Results demonstrate that diverse sources of knowledge were mobilised by practitioners, predominantly derived from the patients themselves -their bodies and their narratives. This reflected principles of patient-centredness. The use of discipline specific forms of knowledge and references to biomedical sources illustrated ongoing efforts towards legitimacy for CM practice. CONCLUSION: CM practitioners are navigating tensions between what some might see as competing, others as complementary, forms of knowledge. The classification system provides a useful tool for promoting critically reflective practice by CM practitioners, particularly in relation to self-assessment of knowledge translation and patient interactions.

Women Taking a Folic Acid Supplement in Countries with Mandatory Food Fortification Programs May Be Exceeding the Upper Tolerable Limit of Folic Acid: A Systematic Review.

BACKGROUND: In preconception and pregnancy, women are encouraged to take folic acid-based supplements over and above food intake. The upper tolerable limit of folic acid is 1000 mcg per day; however, this level was determined to avoid masking a vitamin B12 deficiency and not based on folic acid bioavailability and metabolism. This review's aim is to assess the total all-source intake of folate in women of childbearing age and in pregnancy in high-income countries with folate food fortification programs. METHODS: A systematic search was conducted in five databases to find studies published since 1998 that reported folate and folic acid intake in countries with a mandatory fortification policy. RESULTS: Women of childbearing age do not receive sufficient folate intake from food sources alone even when consuming fortified food products; however, almost all women taking a folic acid-based supplement exceed the upper tolerable limit of folic acid intake. CONCLUSIONS: Folic acid supplement recommendations and the upper tolerable limit of 1000 mcg set by policy makers warrant careful review in light of potential adverse effects of exceeding the upper tolerable limit on folic acid absorption and metabolism, and subsequent impacts on women's health during their childbearing years.

International prevalence of consultation with a naturopathic practitioner: a systematic review and meta-analysis.

OBJECTIVES: Naturopathy is a traditional medicine system informed by codified philosophies and principles, and an emphasis on non-pharmacologic therapeutic interventions. While naturopathy is practised by approximately 75 000-100 000 000 naturopathic practitioners in at least 98 countries, little is known about the international prevalence of history of consultation with a naturopathic practitioner. This study reports a systematic review and meta-analysis of studies describing the global prevalence of history of consultation with a naturopathic practitioner by the general population. SETTING: The included literature was identified through a systematic search of eight databases between September and October 2019, as well as the grey literature. PARTICIPANTS: Studies were included if they reported the prevalence rate of consultations with a naturopathic practitioner by the general population. INTERVENTIONS: Survey items needed to report consultations with a naturopathic practitioner as defined in the country where data was collected, and not combine naturopathic consultations with other health services or only report consulations for illness populations. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary measures used for the analysis was consultations in the previous 12 months. Other prevalence timeframes were reported as secondary measures. METHODS: Meta-analysis of prevalence data was conducted using random effects models based on individual countries and WHO world regions. RESULTS: The literature search identified eight manuscripts summarising 14 studies reporting prevalence for inclusion in the review. All included studies had a low risk of bias. Meta-analysis of the included studies by world region found the 12-month prevalence of history of naturopathy consultations ranged from 1% in the Region of the Americas to 6% in the European and Western Pacific Regions. CONCLUSIONS: There are up to sixfold differences in the prevalence of naturopathy consults over 12 months between and within world regions, which may be driven by a range of policy, legislative and social factors. PROSPERO REGISTRATION NUMBER: CRD42020145529.