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May, 2013 - VOL. 19, NO. 3 | |
May, 2013 |
| Use of and Attitude Toward Complementary and Alternative Medicine: Understanding the Role of Generational Influence |
| Sarah M. Artani, MS; Shivani K. Mhatre, MS; Sujit S. Sansgiry, PhD |
| Context • The prevalence of the use of complementary and alternative medicine (CAM) is increasing in developed countries, including the United States. Some patients use CAM without informing their physicians, subjecting themselves to potentially dangerous contraindications. Identifying patient populations that have an inclination to use CAM can help physicians provide patient-centered care, ensuring better health outcomes.
Objective • This study aimed to explore the role of generational influences on the use of and attitudes toward CAM.
Design • The research team designed a cross-sectional survey that classified participants into four generational-influence categories: (1) category 1—students who recently had left another country to reside in the United States without their parents, (2) category 2—students who had left another country to reside in the United States with their parents, (3) category 3—students born in the United States whose parents were born or immigrated to the United States but whose grandparents were not born in the United States, and (4) category 4—students born in the United States whose parents and grandparents were born in the United States.
Setting • The study took place at the University of Houston in Houston, Texas
Participants • Participants were 400 students from the university.
Outcome Measures • Variance was measured using a 6-item, 5-point Likert scale, analyzing differences in attitudes toward CAM. Multiple logistic and linear regressions analyses assessed the influence of generation on use of and attitudes toward CAM, respectively.
Results • Participants in category 1 reported the highest CAM use (43.6%) and had the most positive attitude toward CAM, which significantly differed from the other categories. After controlling for covariates, generational influence as categorized was a significant (P < .05) predictor of attitude toward CAM, which in turn was a significant (P < .0001) predictor of CAM use.
Conclusions • Attitudes toward CAM vary significantly by generational influence. Recent immigrants gradually assimilate and change their cultural beliefs about CAM use, and they had the highest use of and the most positive attitude toward CAM. Physicians may want to consider integrating CAM treatments for patients who have recently immigrated to the United States to enhance treatment compliance. (Altern Ther Health Med. 2013;19(3):10-15.) |
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May, 2013 - VOL. 19, NO. 3 | |
May, 2013 |
| A Pilot Study on the Serum Pharmacokinetics of Nattokinase in Humans Following a Single, Oral, Daily Dose |
| Michael Ero, MT, CLS, MBA; Nathaniel Harvey, BS; Brad Lewis, MD; Tamara Mihailovski, MS, CLS; Connie Ng, CLS |
| Context • Nattokinase is a serine protease and is derived from natto, a traditional Japanese, fermented, soybean food meal. Multiple authors have described the significant fibrinolytic, antithrombotic, and antihypertensive effects of natto. Nattokinase has been growing in popularity for use as a dietary supplement for the benefit of cardiovascular health. Little is known regarding the pharmacokinetic and pharmacodynamic properties of this enzyme, and the bioavailability of nattokinase is currently unknown.
Objective • This study intended to (1) detect nattokinase directly and immunologically, (2) show that nattokinase and/or its metabolites were detectable in human blood following ingestion of a commercial preparation, and (3) chart a pharmacokinetic dosing effect for nattokinase.
Design • The research team designed the pilot study as an in vivo, human clinical trial. Healthy human subjects responded to an advertisement and were screened. Subjects who satisfied both inclusion and exclusion criteria were enrolled into the study. Subjects were then instructed to orally ingest a single capsule containing a known concentration of nattokinase immediately following a baseline blood draw. Subsequent blood draws occurred over a 24-h period.
Setting • This study was conducted in Oakland, California, at a clinical reference laboratory and was performed with the approval of an institutional review board (IRB) to ensure that appropriate ethical standards were met.
Participants • Eleven healthy participants (five male, six female, ages 21-65), who met eligibility criteria, were enrolled. |
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May, 2013 - VOL. 19, NO. 3 | |
May, 2013 |
| Topical Curcumin for the Prevention of Oral Mucositis in Pediatric Patients: Case Series |
| Sharon Elad, DMD, MSc; Irit Meidan, DMD; Shoshana Revel-Vilk, MD, MSc; Gila Sellam, RN; Sohair Simaan, RN; Elisha Waldman, MD; Michael Weintraub, MD; Itai Zeevi, DMD |
| Background • Oral mucositis is a common complication of cancer therapy. Animal models suggest that curcumin may prevent oral mucositis. To date, no clinical studies have been reported.
Objective • The primary aim of this pilot study was to assess the tolerability of a curcumin mouthwash. The secondary aim was to describe oral mucositis in pediatric patients undergoing doxorubicin-containing chemotherapy who were using the curcumin mouthwash.
Method • The research team had originally designed a placebo-controlled study, but gastrointestinal adverse events (nausea and vomiting) affected the compliance of the first three participants who entered the study. An independent researcher found that all three had received the placebo. Believing it unethical to continue using the study’s original design, the research team discontinued the control group, and the resulting study is comparable to a case series.
Setting • The research team performed the study at Hadassah University Medical Center in Jerusalem, Israel.
Participants • Participants were seven pediatric and young-adult oncology patients.
Intervention • In addition to standard, preventive oral care (chlorhexidine 0.2% mouthwash for 30 s twice per day), participants also used 10 drops of Curcumall twice per day in a mouthwash during treatment with high-dose chemotherapy.
Primary Outcome Measures • Oral mucositis was assessed on days 0, 7, 10, 14, and 21. The World Health Organization (WHO) scale, the Oral Mucositis Assessment Scale (OMAS), and a Visual Analog pain scale (VAS; patient reporting scale of 0-10) were used. Adverse events were tracked.
Results • No oral adverse events were documented. No systemic adverse events that possibly could be related to the use of the curcumin mouthwash were observed. In the four patients who fulfilled the compliance criteria, the WHO, OMAS and VAS scores were lower than the severity of oral mucositis previously reported in the literature. Four out of the five participants developed OM, but the values were low, reflecting a relatively mild case.
Conclusion • In this study, the research team suggested that curcumin mouthwash was safe and well-tolerated. More research is warranted about the efficacy of topical curcumin in the prevention of oral mucositis. (Altern Ther Health Med. 2013;19(3):21-24.) |
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May, 2013 - VOL. 19, NO. 3 | |
May, 2013 |
| Effects of Noninvasive Electroacupuncture on Labor Pain, Adrenocorticotropic Hormone, and Cortisol |
| Muruvvet Baser, RN, PhD; Salime Mucuk, RN, PhD; Tulay Ozkan, RN, PhD |
| Context • Labor pain is the most painful experience in a mother’s life. Acupuncture has been reported to be useful for pain relief during labor.
Objective • The study was designed to assess the effects of noninvasive electroacupuncture at Hegu (LI4) on labor pain and on adrenocorticotropic hormone (ACTH) and cortisol levels.
Design • The study was randomized, with an experimental acupuncture group (AG) and a control group (CG).
Setting • The study was conducted at the Kayseri Maternity Hospital in Turkey, over a period of 6 months in 2010.
Participants • Participants were women in the active phase of labor.
Intervention • For the acupuncture group (AG), bilateral, Hegu acupuncture points were stimulated using a transcutaneous electrical nerve stimulation (TENS) acupuncture pen for 20 min in total. The control group did not receive acupuncture. All women received routine and standard nursing care and treatments.
Primary Outcome Measures • Blood ACTH and cortisol levels and visual analogue scale (VAS) scores were compared between the AG and CG to evaluate the efficacy of acupuncture treatment.
Results • Blood ACTH and cortisol levels and VAS scores were lower in the AG than in the CG; however, these differences did not reach a statistically significant level.
Conclusion • In this study, blood ACTH and cortisol levels and VAS scores were affected by electroacupuncture intervention on Hegu (LI4), although the result was not statistically significant. (Altern Ther Health Med. 2013;19(3):26-30.) |
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May, 2013 - VOL. 19, NO. 3 | |
May, 2013 |
| Narrative Review of Yoga Intervention Clinical Trials Including Weight-related Outcomes |
| Jennifer Rioux, PhD, CAP, RYT; Cheryl Ritenbaugh, PhD, MPH |
| Context • Medical authorities have identified obesity as a causal factor in the development of diabetes, hypertension, and cardiovascular disease (CVD), and more broadly, of metabolic syndrome/insulin resistance syndrome. To provide solutions that can modify this risk factor, researchers need to identify methods of effective risk reduction and primary prevention of obesity. Research on the effectiveness of yoga as a treatment for obesity is limited, and studies vary in overall quality and methodological rigor.
Objective • This narrative review assessed the quantity and quality of clinical trials of yoga as an intervention for weight loss or as a means of risk reduction or treatment for obesity and diseases in which obesity is a causal factor. This review summarized the studies’ research designs and evaluated the efficacy of yoga for weight loss via the current evidence base.
Design • The research team evaluated published studies to determine the appropriateness of research designs, comparability of programs’ intervention elements, and standardization of outcome measures. The research team’s literature search used the key terms yoga and obesity or yoga and weight loss in three primary medical-literature databases (PubMed, PsychInfo, and Web of Science). The study excluded clinical trials with no quantitative obesity-related measure. Extracted data included each study’s (1) design; (2) setting and population; (3) nature, duration, and frequency of interventions; (4) comparison groups; (5) recruitment strategies; (6) outcome measures; (7) data analysis and presentation; and (8) results and conclusions. The research team developed an overall evaluation parameter to compare disparate trials.
Outcome Measures • The research team reviewed each study to determine its key features, each worth a specified number of points, with a maximum total of 20 points. The features included a study’s (1) duration, (2) frequency of yoga practice, (3) intensity of (length of) each practice, (4) number of yogic elements, (5) inclusion of dietary modification, (6) inclusion of a residential component, (7) the number of weight-related outcome measures, and (8) a discussion of the details of the yogic elements.
Results • Overall, therapeutic yoga programs are frequently effective in promoting weight loss and/or improvements in body composition. The effectiveness of yoga for weight loss is related to the following key features: (1) an increased frequency of practice; (2) a longer intervention duration (3) a yogic dietary component; (4) a residential component; (5) the comprehensive inclusion of yogic components; (5) and a home-practice component.
Conclusions • Yoga appears to be an appropriate and potentially successful intervention for weight maintenance, prevention of obesity, and risk reduction for diseases in which obesity plays a significant causal role. (Altern Ther Health Med. 2013;19(3):32-46.) |
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May, 2013 - VOL. 19, NO. 3 | |
May, 2013 |
| Michael Roizen, MD: Motivating Patients to Live Younger and the Fatal Flaw of Wellness Programs |
| Craig Gustafson |
| Michael F. Roizen, MD, is a graduate of Williams College and the University of California, San Francisco, School of Medicine. He performed his residency in internal medicine at Harvard’s Beth Israel Hospital and completed Public Health Service at the National Institutes of Health. Dr Roizen is the cofounder and chair of the RealAge, Inc, Scientific Advisory Board. He is 67 calendar years of age, but his RealAge is 47.8. Dr Roizen is a past chair of a Food and Drug Administration advisory committee and a former editor for six medical journals. He has published more than 165 peer-reviewed scientific papers, 100 textbook chapters, 30 editorials, and four medical books (one a medical best seller), and he received 13 US patents and many foreign patents. His first general-audience book, RealAge: Are You as Young as You Can Be? became a #1 New York Times best seller and was awarded the Best Wellness Book of 1999 by the Books for a Better Life Awards. RealAge has been translated into more than 20 languages and was #1 in four other countries. He has subsequently authored or coauthored 8 other bestsellers and four #1 bestsellers now translated into 44 languages. Dr Roizen has given over 1400 lectures to professional medical groups and has been recognized with over 20 professional lectureships. Dr Roizen practices anesthesiology and internal medicine, using the RealAge metric to motivate his patients. He enjoys getting his patients to throw away their medications when they no longer need them, but he teaches the role of food and other simple steps in reversing disease processes. The Wellness Institute that he chairs includes Employee Health and Wellness, the Department of Preventive Medicine, Premium Access Programs, Disease Reversal and Integrative Medicine Programs, and the Wellness Public Policy and Community Support Programs of Cleveland Clinic. Cleveland Clinic Wellness Institute aims to elevate preventive care and wellness as a core brand and a core value taught to patients and employees. (Altern Ther Health Med. 2013;19(3):48-54.) |
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May, 2013 - VOL. 19, NO. 3 | |
May, 2013 |
| Magnesium: Not to Be Overlooked |
| Andrew W. Campbell, MD |
| Sometimes one can overlook simple things, such as the importance of magnesium (Mg)—not only for maintaining good health in our patients by supplementation but also in various conditions where low Mg contributes to the symptoms that trigger our patients’ complaints.
We are all taught about Mg sometime during our training in health care. Low Mg levels have been implicated in diabetes, metabolic syndrome, osteoporosis, and asthma. Supplementation with Mg can help patients with fibromyalgia and can help prevent myocardial infarctions and stroke. It is used in patients with cardiac arrhythmias.1 Though many health care professionals rely on serum levels of Mg and red blood cell Mg, the most accurate method for measuring Mg in a patient is via intravenous loading dose.2
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