Naturopathic Management of Acute Pediatric Respiratory Infections: A Modified Delphi Study.

Objective: Both the United Nations and the World Health Organization have identified antimicrobial resistance as a significant threat to global health. The Centers for Disease Control and Prevention identified five pediatric respiratory conditions as requiring particular scrutiny in terms of antibiotic stewardship. This study sought to identify strategies used by experienced naturopathic practitioners to treat acute respiratory infections in children. The authors theorize that naturopathic strategies safely fill the gap between watchful waiting and antibiotic prescription, thus reducing the use of antibiotics. Methods: Naturopathic practitioners in Canada, the United States, and Australia with a minimum of 5 years of experience in clinical naturopathic care of children were recruited for a modified Delphi study. A 14-person panel of practitioners was selected to complete a series of four iterative surveys assessing agreement to statements in five domains of knowledge/attitudes, assessment/diagnosis, management, monitoring, and education. Items were deemed to have reached consensus if they reached a predetermined threshold of 70% agreement, or failed to reach a threshold of 40% agreement. Items between these boundaries were modified and retested until either consensus was reached or the four surveys had been completed. Results: Results yielded a large degree of agreement on core naturopathic approaches to the management of acute pediatric respiratory infections, especially lifestyle strategies, including adequate rest and dietary recommendations. The use of vitamins C and D was strongly supported, as were herbs, particularly echinacea and elderberry. Some hydrotherapy and topical applications specific to the individual focus on infection also reached consensus. Results suggested that most respondents, even if they have the authority to prescribe antibiotics, rarely deem it necessary to do so. Conclusion: Findings of this study provide (1) clarity on the role of naturopathic doctors in the management of pediatric health concerns and the stewardship of antibiotics; and (2) initial guidance to less experienced naturopathic practitioners. The findings also identify key priorities for research into the safety and effectiveness of naturopathic interventions to reduce the unnecessary prescribing of antibiotics.

How are Medical Institutions Supporting the Well-being of Undergraduate Students? A Scoping Review.

INTRODUCTION: Medical students experience significant stress and impacts on mood due to multiple factors. Unmitigated stress impacts both physical and mental health while increasing the risk of unethical behavior. It is important for medical institutions to identify strategies that effectively reduce perceived stress and improve the well-being of their students. METHODS: The authors undertook a scoping review of the literature to identify strategies implemented by medical educational programs to improve the well-being of medical students. RESULTS: Of 1068 articles identified, 19 studies met the inclusion criteria. Interventions were categorized as mindfulness-based programs, reflection groups, curriculum changes, and 'miscellaneous.' All studies assessed outcomes of student stress/resilience, as well as additional domains including academic performance, mental health, and interpersonal skills. Some also assessed the acceptability of the intervention to students. CONCLUSIONS: Despite the heterogeneity of interventions and outcome measures, a clear theme emerged that institutionally-provided strategies to promote student well-being tend to be effective when students opt into the program. It was noted that adding mandatory content or activities to a medical program without creating adequate space or support for it can have the opposite effect. Further high quality intervention studies involving randomization, blinding and rigorous controls are warranted.

The critical intersection of environmental and social justice: a commentary.

The global crises of ecological degradation and social injustice are mutually reinforcing products of the same flawed systems. Dominant human culture is morally obliged to challenge and reconstruct these systems in order to mitigate future planetary harm. In this commentary, we argue that doing so requires a critical examination of the values and narratives which underlie systems of oppression and power. We argue for the moral necessity of a socially just approach to the ecological crisis.

Scope of Practice and Principles of Care of Naturopathic Medicine in North America: A Commentary.

Naturopathic medicine is a growing profession in North America that provides expertise in complementary and alternative, or integrative care to pediatric patients. It is imperative that healthcare providers have an understanding of the training and scope of other health professionals in order to effectively make decisions regarding research, collaborative clinical care, and policy. Given the prevalence of use of complementary and alternative medicine by children and families in North America, and the growing interest in "integrative" medicine, we aim to offer an overview of naturopathic care for children. This document describes the principles, training, and scope of naturopathic medicine, including health promotion, disease prevention, and illness management. It describes the process by which naturopathic doctors create an integrative healthcare plan for children, evaluate and apply evidence, and integrate ethical issues in practice management, and speaks to the role naturopathic doctors have regarding advocacy for community and planetary health as it relates to pediatrics.

Group-Based Naturopathic Education for Primary Prevention of Noncommunicable Disease in Families and Children: A Feasibility Study.

Objectives: Naturopathic medicine has demonstrated efficacy at reducing risk factors for chronic disease. Targeting health behaviors of parents and caregivers in a group-based setting may improve the behaviors of children in their care. This study sought to assess the feasibility of such a program. Design: Participants of a six-session health education series were invited to respond to surveys and participate in a focus group about their health behaviors and their experience in the program. Subjects: Caregivers of children aged 0-6 attending publicly funded community centers in Ontario, Canada. Interventions: A 6-week group-based naturopathic education program to promote healthy lifestyle behaviors among caregivers. Outcome measures: Satisfaction with content and delivery, and frequency of healthy behaviors. Results: The majority of responses indicated satisfaction with the program, and an ongoing benefit 6 weeks and more after completion. There was a clear correlation between healthy behaviors of parents and children. Conclusions: A group-based naturopathic education program may be a feasible method of delivering primary-prevention education to caregivers, particularly in the domains of practicality and acceptability.

Pediatric natural health products recommended by chiropractic and naturopathic doctors in Canada.

OBJECTIVES: To assess chiropractic (DC) and naturopathic doctors' (ND) pediatric care natural health product (NHP) recommendations. DESIGN: Surveys were developed in collaboration with DC and ND educators, and delivered as an on-line national survey. NHP dose, form of delivery, and indications across pediatric age ranges (from newborn to 16 years) for each practitioner's top five NHPs were assessed. Data were analyzed using descriptive statistics, t-tests, and non-parametric tests. RESULTS: Of the 421 respondents seeing one or more pediatric patients per week, 172 (41%, 107 DCs, 65 NDs) provided 440 NHP recommendations, categorized as: vitamins and minerals (89 practitioners, 127 recommendations), probiotics (110 practitioners, 110 recommendations), essential fatty acids (EFAs: 72 practitioners, 72 recommendations), homeopathics (56 practitioners, 66 recommendations), botanicals (29 practitioners, 31 recommendations), and other NHPs (33 practitioners, 34 recommendations). Indications for the NHP recommendations were tabulated for NHPs with 10 or more recommendations in any age category: 596 total indications for probiotics, 318 indications for essential fatty acids, 138 indications for vitamin D, and 71 indications for multi-vitamins. CONCLUSIONS: This is the first study documenting the pediatric NHP recommendations of two popular complementary medicine professions. Common NHPs at standard doses are the most frequently recommended products, with use and doses adjusted according to age. High-quality evidence regarding the efficacy, safety, and dosing for NHP use in children is scarce; development of evidence-informed pediatric guidelines is recommended, particularly for the most commonly used and recommended NHPs.

Pediatric training and practice of Canadian chiropractic and naturopathic doctors: a 2004-2014 comparative study.

BACKGROUND: To assess chiropractic (DC) and naturopathic doctors' (ND) knowledge, attitudes, and behaviour with respect to the pediatric patients in their practice. METHODS: Cross-sectional surveys were developed in collaboration with DC and ND educators. Surveys were sent to randomly selected DCs and NDs in Ontario, Canada in 2004, and a national online survey was conducted in 2014. Data were analyzed using descriptive statistics, t-tests, non-parametric tests, and linear regression. RESULTS: Response rates for DCs were n = 172 (34%) in 2004, n = 553 (15.5%) in 2014, and for NDs, n = 171 (36%) in 2004, n = 162 (7%) in 2014. In 2014, 366 (78.4%) of DCs and 83 (61%) of NDs saw one or more pediatric patients per week. Pediatric training was rated as inadequate by most respondents in both 2004 and 2014, with most respondents (n = 643, 89.9%) seeking post-graduate training by 2014. Respondents' comfort in treating children and youth is based on experience and post-graduate training. Both DCs and NDs that see children and youth in their practices address a broad array of pediatric health concerns, from well child care and preventative health, to mild and serious illness. CONCLUSIONS: Although the response rate in 2014 is low, the concerns identified a decade earlier remain. The majority of responding DCs and NDs see infants, children, and youth for a variety of health conditions and issues, but self-assess their undergraduate pediatric training as inadequate. We encourage augmented pediatric educational content be included as core curriculum for DCs and NDs and suggest collaboration with institutions/organizations with expertise in pediatric education to facilitate curriculum development, especially in areas that affect patient safety.