Complementary Therapies: A Risk of Rupture with General Medicine? A Qualitative Study About the Personal Health Care Journey of Shiatsu Users in France.

Context: In 2014, the World Health Organization launched its second strategic plan on the development of complementary medicine. Shiatsu is one of eight alternative approaches worthy of interest. No study explored its users' health trajectories and the motives and experiences of their use of shiatsu. Aim: To explore motives and experiences of the use of shiatsu and its users' health care trajectories in France. Design and Setting: Qualitative study with shiatsu users. Methods: Semistructured telephone interviews with shiatsu users and audio recordings during shiatsu sessions. Shiatsu users were recruited across France by shiatsu practitioners who had no specific instructions on the profile of users to include. Descriptive then thematic analysis of data, with triangulation, according to a phenomenological approach, using MAXQDA© software. Results: Ten interviews and seven recordings were made to gather sufficient data. The major themes identified were the previous knowledge and representations of shiatsu, the symptoms leading to this use, the ineffectiveness of conventional medicine and the user's health trajectories. Users were looking for an alternative to conventional medicine and often resorted to other complementary medicines. They generally had no prior knowledge of shiatsu. They were advised to try shiatsu by those around them, never by a physician. Their main reasons for having recourse to shiatsu were pain, anxiety, and sleep disorders. Users initially tried conventional medicine. Some sought to modify or reduce their medicine intake. Shiatsu then became a regular practice. Users described derogatory reactions from their general practitioner (GP) to this complementary therapy. Conclusion: This study highlights a fluctuating and ambivalent relationship between complementary medicine and conventional medicine. Shiatsu users' health care trajectories include several phases: trust in conventional medicine then disappointment, rupture and risk taking for their health. To avoid this rupture, GP should be involved in the use of complementary therapies.

Influence of seasonal and inter-annual hydro-meteorological variability on surface water fecal coliform concentration under varying land-use composition.

Quantifying the influence of hydro-meteorological variability on surface source water fecal contamination is critical to the maintenance of safe drinking water. Historically, this has not been possible due to the scarcity of data on fecal indicator bacteria (FIB). We examined the relationship between hydro-meteorological variability and the most commonly measured FIB, fecal coliform (FC), concentration for 43 surface water sites within the hydro-climatologically complex region of British Columbia. The strength of relationship was highly variable among sites, but tended to be stronger in catchments with nival (snowmelt-dominated) hydro-meteorological regimes and greater land-use impacts. We observed positive relationships between inter-annual FC concentration and hydro-meteorological variability for around 50% of the 19 sites examined. These sites are likely to experience increased fecal contamination due to the projected intensification of the hydrological cycle. Seasonal FC concentration variability appeared to be driven by snowmelt and rainfall-induced runoff for around 30% of the 43 sites examined. Earlier snowmelt in nival catchments may advance the timing of peak contamination, and the projected decrease in annual snow-to-precipitation ratio is likely to increase fecal contamination levels during summer, fall, and winter among these sites. Safeguarding drinking water quality in the face of such impacts will require increased monitoring of FIB and waterborne pathogens, especially during periods of high hydro-meteorological variability. This data can then be used to develop predictive models, inform source water protection measures, and improve drinking water treatment.