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Use of phytoestrogens and effects perceived by postmenopausal women: result of a questionnaire-based survey

July 28, 2014 Comments off

Use of phytoestrogens and effects perceived by postmenopausal women: result of a questionnaire-based survey
Source: BMC Complementary and Alternative Medicine

Background
Use of food supplements-containing phytoestrogens among postmenopausal women is rapidly increasing. Although phytoestrogens are often perceived as safe, evidence for overall positive risk-benefit profile is still inconclusive. The chance to buy them by user’s initiative does not facilitate surveys on their prevalence and pattern of use. The aim of this study was to describe the pattern of use and self-reported positive and negative perceptions of phytoestrogens in post-menopausa.

Methods
A questionnaire was administered to women who were buying food supplements containing phytoestrogens in 22 pharmacies located in the Bologna area (400,000 inhabitants). Questionnaire was structured into 3 sections: (a) socio-demographic information; (b) pattern of use, (c) positive and negative perceptions.

Results
Data on 190 peri- and post-menopausal women (aged 38-77) were collected. Women stated to use phytoestrogens to reduce hot flushes (79%), insomnia (15%), mood disturbances (14%) and prevent osteoporosis (15%). The majority (59%) took phytoestrogens routinely, whereas 28% in 3-month cycles. Among positive perceptions between short- and long-term users, a not negligible difference was reported for relief of hot-flushes (68% in short-term vs. 81% in long-term users; p = 0.04). Negative perceptions were reported more frequently in the long-term group, and this difference was statistically significant for edema (6% in short-term vs. 17% in long-term users; p = 0.04), but not for other effects: e.g., swelling sensation (10% vs. 21%; p = 0.09), somnolence (7% vs. 10% p = 0.62), fatigue (4% vs.11% p = 0.15).

Conclusions
In the Bologna area, the pattern of use of phytoestrogens for menopausal symptoms is heterogeneous, and women overall find these substances to be beneficial, especially for relief of hot-flushes. Other positive perceptions decreased with long-term use. Negative perceptions, especially estrogen-like effects, seem to be infrequent and increase with long-term therapy. Physicians should pay attention to effects perceived by post-menopausal women and routinely monitor the use of phytoestrogens, in order to recognize possible adverse effects and actual benefits.

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Use of St. John’s Wort in Potentially Dangerous Combinations

July 22, 2014 Comments off

Use of St. John’s Wort in Potentially Dangerous Combinations
Source: Journal of Alternative and Complementary Medicine

Objectives:
The objective of this study was to assess how often St. John’s wort (SJW) is prescribed with medications that may interact dangerously with it.

Design:
The study design was a retrospective analysis of nationally representative data from the National Ambulatory Medical Care Survey.

Settings:
The study setting was U.S. nonfederal outpatient physician offices.

Subjects:
Those prescribed SJW between 1993 and 2010 were the subjects.

Outcome Measures:
The outcome measures were medications co-prescribed with SJW.

Results: Twenty-eight percent (28%) of SJW visits involved a drug that has potentially dangerous interaction with SJW. These included selective serotonin reuptake inhibitors, benzodiazepines, warfarin, statins, verapamil, digoxin, and oral contraceptives.

Conclusions:
SJW is frequently used in potentially dangerous combinations. Physicians should be aware of these common interactions and warn patients appropriately.

Using Dietary Supplements Wisely

July 18, 2014 Comments off

Using Dietary Supplements Wisely
Source: National Center for Complementary and Alternative Medicine

Like many Americans, you may take dietary supplements in an effort to stay healthy. With so many dietary supplements available and so many claims made about their health benefits, how can you decide whether a supplement is safe or useful? This fact sheet provides a general overview of dietary supplements, discusses safety considerations, and suggests sources for additional information.

Mind and Body Practices for Fibromyalgia

July 8, 2014 Comments off

Mind and Body Practices for Fibromyalgia
Source: National Center for Complementary and Alternative Medicine

Fibromyalgia syndrome is a common and chronic disorder characterized by widespread pain, diffuse tenderness, fatigue, and a number of other symptoms that can interfere with a person’s ability to carry out daily activities. It is estimated that fibromyalgia affects 5 million American adults. Most people with fibromyalgia—between 80 and 90 percent—are women. However, men and children also can have the disorder, which is often associated with other syndromes. The causes of fibromyalgia are unknown, but there are probably a number of factors involved. Recently, researchers have focused on abnormalities in processing of pain by the central nervous system.

Fibromyalgia can be difficult to diagnose and treat. Current diagnostic criteria are available from the American College of Rheumatology. Treatment often involves an individualized approach that may include both pharmacologic therapies (prescription drugs, analgesics, and NSAIDs) and nonpharmacologic interventions such as exercise, muscle strength training, cognitive behavioral therapy, movement/body awareness practices, massage, acupuncture, and balneotherapy.

Five-Week Outcomes From a Dosing Trial of Therapeutic Massage for Chronic Neck Pain

June 20, 2014 Comments off

Five-Week Outcomes From a Dosing Trial of Therapeutic Massage for Chronic Neck Pain
Source: Annals of Family Medicine

PURPOSE
This trial was designed to evaluate the optimal dose of massage for individuals with chronic neck pain.

METHODS
We recruited 228 individuals with chronic nonspecific neck pain from an integrated health care system and the general population, and randomized them to 5 groups receiving various doses of massage (a 4-week course consisting of 30-minute visits 2 or 3 times weekly or 60-minute visits 1, 2, or 3 times weekly) or to a single control group (a 4-week period on a wait list). We assessed neck-related dysfunction with the Neck Disability Index (range, 0–50 points) and pain intensity with a numerical rating scale (range, 0–10 points) at baseline and 5 weeks. We used log-linear regression to assess the likelihood of clinically meaningful improvement in neck-related dysfunction (≥5 points on Neck Disability Index) or pain intensity (≥30% improvement) by treatment group.

RESULTS
After adjustment for baseline age, outcome measures, and imbalanced covariates, 30-minute treatments were not significantly better than the wait list control condition in terms of achieving a clinically meaningful improvement in neck dysfunction or pain, regardless of the frequency of treatments. In contrast, 60-minute treatments 2 and 3 times weekly significantly increased the likelihood of such improvement compared with the control condition in terms of both neck dysfunction (relative risk = 3.41 and 4.98, P = .04 and .005, respectively) and pain intensity (relative risk = 2.30 and 2.73; P = .007 and .001, respectively).

CONCLUSIONS
After 4 weeks of treatment, we found multiple 60-minute massages per week more effective than fewer or shorter sessions for individuals with chronic neck pain. Clinicians recommending massage and researchers studying this therapy should ensure that patients receive a likely effective dose of treatment.

Melatonin: What You Need To Know

June 4, 2014 Comments off

Melatonin: What You Need To Know
Source: National Center for Complimentary and Alternative Medicine

What’s the Bottom Line?

How much do we know about melatonin supplements?
Researchers have conducted many studies on whether melatonin supplements may help people with various sleep disorders; however, important questions remain about its usefulness, how much to take and when to take it, and long-term safety.

What do we know about the usefulness of melatonin supplements?
Melatonin supplements may help some people with certain sleep disorders, including jet lag, sleep problems related to shift work, and delayed sleep phase disorder (one in which people go to bed but can’t fall asleep until hours later), and insomnia.

What do we know about the safety of melatonin supplements?
Melatonin supplements appear to be safe when used short-term; less is known about long-term safety.

NCCAM Clinical Digest: Dietary Supplements for Osteoarthritis

June 2, 2014 Comments off

NCCAM Clinical Digest: Dietary Supplements for Osteoarthritis
Source: National Center for Complementary and Alternative Medicine

Osteoarthritis, which affects an estimated 27 million Americans, is a leading cause of disability in older adults. Because the general population is aging and obesity, a major risk factor, is increasing in prevalence, the occurrence of osteoarthritis is on the rise. Clinical practice guidelines issued by the American College of Rheumatology recommend aerobic exercise and/or strength training, weight loss (if overweight), and a number of pharmacological and non-pharmacological modalities for treating OA of the knee, hip, or hand.

Many people with OA report trying various dietary supplements in an effort to relieve pain and improve function. However, there is no convincing evidence that any dietary supplement helps with OA symptoms or the underlying course of the disease. This issue of the digest summarizes current scientific evidence about several dietary supplements most often used by people with OA, including glucosamine and chondroitin sulfate, Dimethyl Sulfoxide (DMSO) and Methylsulfonylmethane (MSM), S-Adenosyl-L-methionine (SAMe), and herbal remedies.

Regional Variation in Use of Complementary Health Approaches by U.S. Adults

May 20, 2014 Comments off

Regional Variation in Use of Complementary Health Approaches by U.S. Adults
Source: National Center for Health Statistics

Key findings
Data from the National Health Interview Survey, 2012

  • Use of nonvitamin, nonmineral dietary supplements (17.9%) was greater than any other complementary health approach used by U.S. adults in 2012.
  • The use of practitioner-based chiropractic or osteopathic manipulation was nearly twice as high in the West North Central region as in the United States overall.
  • Use of nonvitamin, nonmineral dietary supplements was highest in the Mountain, Pacific, and West North Central regions.
  • Use of yoga with deep breathing or meditation was approximately 40% higher in the Pacific and Mountain regions than in the United States overall.

Therapeutic Benefits of Cannabis: A Patient Survey

May 2, 2014 Comments off

Therapeutic Benefits of Cannabis: A Patient Survey
Source: Hawaii Journal of Medicine and Public Health

Clinical research regarding the therapeutic benefits of cannabis (“marijuana”) has been almost non-existent in the United States since cannabis was given Schedule I status in the Controlled Substances Act of 1970. In order to discover the benefits and adverse effects perceived by medical cannabis patients, especially with regards to chronic pain, we hand-delivered surveys to one hundred consecutive patients who were returning for yearly re-certification for medical cannabis use in Hawai‘i.

The response rate was 94%. Mean and median ages were 49.3 and 51 years respectively. Ninety-seven per cent of respondents used cannabis primarily for chronic pain. Average pain improvement on a 0–10 pain scale was 5.0 (from 7.8 to 2.8), which translates to a 64% relative decrease in average pain. Half of all respondents also noted relief from stress/anxiety, and nearly half (45%) reported relief from insomnia. Most patients (71%) reported no adverse effects, while 6% reported a cough or throat irritation and 5% feared arrest even though medical cannabis is legal in Hawai‘i. No serious adverse effects were reported.

These results suggest that Cannabis is an extremely safe and effective medication for many chronic pain patients. Cannabis appears to alleviate pain, insomnia, and may be helpful in relieving anxiety. Cannabis has shown extreme promise in the treatment of numerous medical problems and deserves to be released from the current Schedule I federal prohibition against research and prescription.

Sleep Disorders and Complementary Health Approaches : What the Science Says

May 2, 2014 Comments off

Sleep Disorders and Complementary Health Approaches: What the Science Says
Source: National Center for Complementary and Alternative Medicine
Discusses Mind and Body Techniques, Dietary Supplements

See also: 5 Things To Know About Sleep Disorders and Complementary Health Approaches

Bio-Piracy or Prospering Together? Fuzzy Set and Qualitative Analysis of Herbal Patenting by Firms

April 23, 2014 Comments off

Bio-Piracy or Prospering Together? Fuzzy Set and Qualitative Analysis of Herbal Patenting by Firms (PDF)
Source: Harvard Business Working Papers

Since the 1990s, several western firms have filed patents based on medicinal herbs from emerging markets, evoking protests from local stakeholders against ‘bio-piracy’. We explore conditions under which firms and local stakeholders share rents from such patents. Our theoretical model builds on two distinct strategy literatures: firms appropriating rents from new technologies and firms managing stakeholders. We predict that a win-win outcome emerges when the patent strength is moderate and when local stakeholders form a coalition with larger national stakeholders to initiate litigation against the focal firm. We test our predictions using a two-pronged empirical strategy. Our empirical context relates to herbal patents from emerging markets and given that we have a small sample (N=17), we employ a fuzzy set QCA methodology. In addition, we develop four in-depth qualitative case studies to support our predictions.

Acupuncture Research – Areas of High and Low Programmatic Priorities

April 15, 2014 Comments off

Acupuncture Research – Areas of High and Low Programmatic Priorities
Source: National Center for Complementary and Alternative Medicine

On this page:

  • Published Research
  • Areas of High Programmatic Priority
  • Areas of Low Programmatic Priority
  • NCCAM Contact Information
  • Selected References

NCCAM Clinical Digest: Chronic Low-Back Pain and Complementary Health Approaches

April 4, 2014 Comments off

NCCAM Clinical Digest: Chronic Low-Back Pain and Complementary Health Approaches
Source: National Center for Complementary and Alternative Medicine

This issue of the digest summarizes current scientific evidence about spinal manipulation, acupuncture, massage, and yoga, the complementary approaches most often used by people for chronic low back pain.

AMTA Releases White Paper on Music Therapy & Military

March 6, 2014 Comments off

AMTA Releases White Paper on Music Therapy & Military
Source: American Music Therapy Association

The American Music Therapy Association (AMTA) announces the publication of Music Therapy and Military Populations: A Status Report and Recommendations on Music Therapy Treatment, Programs, Research, and Practice Policy. This landmark report discusses the profession of music therapy with a focus on both active duty service members and veterans.

The music therapy profession’s rich, enduring contributions to readiness, rehabilitation, recovery, and wellness among America’s military populations are explored. The white paper presents exemplary model programs and highlights the strong foundation of published research and evidence to inform practice. This information provides the groundwork to improve access to music therapy services among military populations and inform strategic plans for expanded and prioritized implementation of music therapy programs, research, and practice policy in the military.

Massage Therapy for Health Purposes: What You Need To Know

February 27, 2014 Comments off

Massage Therapy for Health Purposes: What You Need To Know
Source: National Center for Complementary and Alternative Medicine

A lot of the scientific research on massage therapy is preliminary or conflicting, but much of the evidence points toward beneficial effects on pain and other symptoms associated with a number of different conditions. Much of the evidence suggests that these effects are short term and that people need to keep getting massages for the benefits to continue.

Credentialing: Understanding the Education, Training, Regulation, and Licensing of Complementary Health Practitioners

February 14, 2014 Comments off

Credentialing: Understanding the Education, Training, Regulation, and Licensing of Complementary Health Practitioners
Source: National Center for Complementary and Alternative Medicine

Health care providers’ credentials—the licenses, certificates, and diplomas on their office walls—tell us about their professional qualifications to advise and treat us. In the United States, local and state governments and professional organizations establish the credentials that complementary health practitioners need to treat patients. This fact sheet provides a general overview of the credentialing of practitioners and suggests sources for additional information.

Chronic Pain and Complementary Health Approaches: What You Need To Know

February 12, 2014 Comments off

Chronic Pain and Complementary Health Approaches: What You Need To Know
Source: National Center for Complementary and Alternative Medicine

What’s the Bottom Line?

Are complementary health approaches for chronic pain safe?
There’s no simple answer to this question. Although many of the complementary approaches studied for chronic pain have good safety records, that doesn’t mean that they’re risk-free for everyone. Your age, health, special circumstances (such as pregnancy), and medicines or supplements that you take may affect the safety of complementary approaches.

Are any complementary health approaches for chronic pain effective?
The currently available evidence is not strong enough to allow definite conclusions to be reached about whether complementary approaches are effective for chronic pain. However, a growing body of scientific evidence suggests that some of these approaches, such as massage, spinal manipulation, and yoga, may help to manage some painful conditions.

Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force

December 18, 2013 Comments off

Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force
Source: Annals of Internal Medicine

Background: Vitamin and mineral supplements are commonly used to prevent chronic diseases.

Purpose: To systematically review evidence for the benefit and harms of vitamin and mineral supplements in community-dwelling, nutrient-sufficient adults for the primary prevention of cardiovascular disease (CVD) and cancer.

Data Sources: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects were searched from January 2005 to 29 January 2013, with manual searches of reference lists and gray literature.

Study Selection: Two investigators independently selected and reviewed fair- and good-quality trials for benefit and fair- and good-quality trials and observational studies for harms.

Data Extraction: Dual quality assessments and data abstraction.

Data Synthesis: Two large trials (n = 27 658) reported lower cancer incidence in men taking a multivitamin for more than 10 years (pooled unadjusted relative risk, 0.93 [95% CI, 0.87 to 0.99]). The study that included women showed no effect in that group. High-quality studies (k = 24; n = 324 653) of single and paired nutrients (such as vitamins A, C, or D; folic acid; selenium; or calcium) were scant and heterogeneous and showed no clear evidence of benefit or harm. Neither vitamin E nor β-carotene prevented CVD or cancer, and β-carotene increased lung cancer risk in smokers.

Limitations: The analysis included only primary prevention studies in adults without known nutritional deficiencies. Studies were conducted in older individuals and included various supplements and doses under the set upper tolerable limits. Duration of most studies was less than 10 years.

Conclusion: Limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or CVD. Two trials found a small, borderline-significant benefit from multivitamin supplements on cancer in men only and no effect on CVD.

DNA barcoding detects contamination and substitution in North American herbal products

November 5, 2013 Comments off

DNA barcoding detects contamination and substitution in North American herbal products
Source: BMC Medicine

Background
Herbal products available to consumers in the marketplace may be contaminated or substituted with alternative plant species and fillers that are not listed on the labels. According to the World Health Organization, the adulteration of herbal products is a threat to consumer safety. Our research aimed to investigate herbal product integrity and authenticity with the goal of protecting consumers from health risks associated with product substitution and contamination.

Methods
We used DNA barcoding to conduct a blind test of the authenticity for (i) 44 herbal products representing 12 companies and 30 different species of herbs, and (ii) 50 leaf samples collected from 42 herbal species. Our laboratory also assembled the first standard reference material (SRM) herbal barcode library from 100 herbal species of known provenance that were used to identify the unknown herbal products and leaf samples.

Results
We recovered DNA barcodes from most herbal products (91%) and all leaf samples (100%), with 95% species resolution using a tiered approach (rbcL + ITS2). Most (59%) of the products tested contained DNA barcodes from plant species not listed on the labels. Although we were able to authenticate almost half (48%) of the products, one-third of these also contained contaminants and or fillers not listed on the label. Product substitution occurred in 30/44 of the products tested and only 2/12 companies had products without any substitution, contamination or fillers. Some of the contaminants we found pose serious health risks to consumers.

Conclusions
Most of the herbal products tested were of poor quality, including considerable product substitution, contamination and use of fillers. These activities dilute the effectiveness of otherwise useful remedies, lowering the perceived value of all related products because of a lack of consumer confidence in them. We suggest that the herbal industry should embrace DNA barcoding for authenticating herbal products through testing of raw materials used in manufacturing products. The use of an SRM DNA herbal barcode library for testing bulk materials could provide a method for ‘best practices? in the manufacturing of herbal products. This would provide consumers with safe, high quality herbal products.

Acupuncture and Counselling for Depression in Primary Care: A Randomised Controlled Trial

October 15, 2013 Comments off

Acupuncture and Counselling for Depression in Primary Care: A Randomised Controlled Trial
Source: PLoS Medicine

Background
Depression is a significant cause of morbidity. Many patients have communicated an interest in non-pharmacological therapies to their general practitioners. Systematic reviews of acupuncture and counselling for depression in primary care have identified limited evidence. The aim of this study was to evaluate acupuncture versus usual care and counselling versus usual care for patients who continue to experience depression in primary care.

Methods and Findings
In a randomised controlled trial, 755 patients with depression (Beck Depression Inventory BDI-II score ≥20) were recruited from 27 primary care practices in the North of England. Patients were randomised to one of three arms using a ratio of 2:2:1 to acupuncture (302), counselling (302), and usual care alone (151). The primary outcome was the difference in mean Patient Health Questionnaire (PHQ-9) scores at 3 months with secondary analyses over 12 months follow-up. Analysis was by intention-to-treat.

PHQ-9 data were available for 614 patients at 3 months and 572 patients at 12 months. Patients attended a mean of ten sessions for acupuncture and nine sessions for counselling. Compared to usual care, there was a statistically significant reduction in mean PHQ-9 depression scores at 3 months for acupuncture (−2.46, 95% CI −3.72 to −1.21) and counselling (−1.73, 95% CI −3.00 to −0.45), and over 12 months for acupuncture (−1.55, 95% CI −2.41 to −0.70) and counselling (−1.50, 95% CI −2.43 to −0.58). Differences between acupuncture and counselling were not significant. In terms of limitations, the trial was not designed to separate out specific from non-specific effects. No serious treatment-related adverse events were reported.

Conclusions
In this randomised controlled trial of acupuncture and counselling for patients presenting with depression, after having consulted their general practitioner in primary care, both interventions were associated with significantly reduced depression at 3 months when compared to usual care alone.

Trial Registration
Controlled-Trials.com ISRCTN63787732

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