Journal of Integrative and Complementary Medicine最新文献

Purpose: This work explores perceptions across a state with both rural and urban populations in an ecologically informed mapping of health care partners to gain a panoramic view of potential barriers and facilitators to using complementary and integrative healthcare (CIH) for nonpharmacological pain management (NPM).

Materials and methods: Semi-structured interviews (N = 48) were conducted with a regionally representative recruitment in six stakeholder groups: chronic pain patients (n = 15), CIH providers (n = 12), clinicians (primary/specialty care providers, nurse practitioners, n = 8), health care administrators (n = 6), and health insurance representatives (n = 7). A six-phase approach using collaborative and iterative thematic analysis was employed.

Results: Findings suggest that themes of determinants exist on a continuum from barrier to facilitator, rather than in isolation. Continuums emerged in four categories of themes: Financial, Logistic, Relational, and Experiential. Major barriers were access, insurance, biases, and education, and major facilitators were partnership, education, and awareness. Ecological nesting of stakeholder major themes showed that perceptions by patients emphasized Financial and Experiential categories; providers emphasized Financial, Logistical, and Relational; administrators emphasized Relational and Experiential; and insurance representatives emphasized Relational.

Conclusion: The continuum model enables use of person-centered scaling of barriers to facilitators in four categories to communicate their own personal context. Socioecological mapping reveals potential differences in perceptions of health care partners. Future work includes systematic review of the literature within the categories and development of a tool to identify person-centered barriers, needs, and facilitators to utilization of CIH for NPM.

Introduction: It is well established that there is a significant health gap between Indigenous and non-Indigenous Australians, with access to health care being a contributing factor. Aboriginal Health in Aboriginal Hands (AHAH) is an allied health service based at an Indigenous community center. Its objectives are to provide allied health services that are not commonly accessed by members of the Indigenous community. The aims of this study were to investigate stakeholders' perceptions of the service and alignment with the principles of delivering allied health services to Indigenous communities.

Methods: Participants were recruited from two distinct groups: (1) Those who had developed, administered, and provided the services (n = 4); and (2) recipients of the services (n = 8). Perceptions of AHAH were collected via individual "yarnings," which involved answering broad questions regarding the service. Data were analyzed using thematic inductive analysis.

Results: Both groups perceived that the "cultural appropriateness" of the setting was essential for its success. This included: its location at an Indigenous community center; the central roles of Indigenous people within the service; being affordable; being welcoming; and being accessible. Another positive attribute was that it provided the opportunity for community members to attain related training and qualifications in areas such as "sports therapy." Both groups perceived that the service could be expanded in terms of more weekly sessions and the inclusion of other allied health services. Staff were aware that while allied health students on placement at the center had undergone some "cultural awareness training," more was needed.

Discussion: Overall, the AHAH service was perceived to align with the five dimensions of accessibility, approachability, acceptability, availability, and affordability, and was being delivered in accordance with the principles of engaging with Aboriginal communities (lore, love, look, listen, learn, lead, and land), which were key attributes contributing to its popularity and success.

Objectives: This study aimed to compare the efficacy of Nigella sativa (N. sativa) mouthwash and chlorhexidine (CHX) in the management of gingivitis. Methods: This triple-blind, parallel-group randomized controlled trial (Iranian Registry of Clinical Trials, IRCT20221212056786N2) was conducted at the Department of Periodontology, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Thirty-six patients aged 20-40 years with gingivitis were randomized in a 1:1 ratio using simple randomization to receive either 20% N. sativa mouthwash or 0.2% CHX mouthwash twice daily for 14 days. Participants, outcome assessors, and statisticians were blinded. Clinical parameters, including plaque index (PI, primary outcome), bleeding index (BI), and staining index (SI), were recorded at baseline and after 14 days. Data were analyzed using analysis of covariance, with statistical significance set at p < 0.05. Results: All 36 participants completed the study. Both N. sativa and CHX mouthwashes significantly reduced PI (mean difference: N. sativa, 33.44 ± 0.72; CHX, 32.72 ± 1.37; p < 0.001 for both) and BI (mean difference: N. sativa, 19.44 ± 0.80; CHX, 19.98 ± 0.81; p < 0.001 for both) after 14 days compared with baseline. Between-group differences were not significant for PI (mean difference: -0.72; 95% confidence interval [CI]: -1.94 to 0.50; p = 0.057) or BI (mean difference: -0.54; 95% CI: -1.10 to 0.02; p = 0.053). A statistically significant but clinically trivial increase in SI was observed in the N. sativa group (mean change: 0.78 ± 1.06; p = 0.006), but not in the CHX group (mean change: 0.44 ± 1.29; p = 0.163). No adverse events, such as taste alteration or mucosal irritation, were reported based on participant self-reports. Conclusions: N. sativa mouthwash showed similar efficacy to CHX in reducing plaque and gingival inflammation over 14 days, suggesting it may be a viable alternative for short-term gingivitis management. However, its potential for slight tooth staining warrants caution, and further studies are needed to assess long-term effects.

Aim: This randomized controlled study aimed to examine the effects of mandala coloring on perceived stress and anxiety levels in patients with type 2 diabetes. Method: This study was conducted between December 2023 and December 2024 with 92 inpatients in the endocrinology clinic of a university hospital. Patients were randomly assigned to the intervention group (n = 46) or control group (n = 46). The intervention group colored one mandala daily for 7 consecutive days, while the control group received routine care. Data were collected using the Personal Information Form, Perceived Stress Scale (PSS), and State Anxiety Scale (SAS). Statistical analyses were performed using two-way mixed ANOVA to examine group, time, and interaction effects, with Bonferroni correction applied for two primary outcomes. The study was reported in accordance with the CONSORT 2010 guidelines. Results: Compared with the control group, the intervention group showed significant reductions in the PSS total score (η² = 0.122, p = 0.000), Inadequate Self-Efficacy subscale (η² = 0.156, p < 0.001), Stress Perception subscale (η² = 0.067, p = 0.013), and SAS score (η² = 0.284, p = 0.000) after the intervention. No adverse events related to mandala coloring were reported. Conclusion: Mandala coloring effectively reduced perceived stress and state anxiety in patients with type 2 diabetes. It may be considered a feasible nursing intervention for the psychological management of these patients.

Objective: To characterize clinicians' familiarity, attitudes, and utilization patterns related to complementary and integrative health (CIH) services at an academic medical center in the United States. Methods: This mixed-methods pilot study surveyed and interviewed clinicians (n = 46), including Department of Integrative Health (DIH) nurses who deliver CIH services via a consult model to hospitalized patients. Self-report questionnaires assessed clinicians' familiarity, attitudes, and utilization of CIH services. Qualitative interviews explored CIH perceived benefits, barriers, and opportunities for wider service adoption. Result: Fifty-six percent of clinicians discussed the benefits of CIH services with patients, and 72% reported positive impacts such as improved sleep, coping, healing, and reduced pain and/or stress. Nurses (n = 25) reporting greater work autonomy viewed CIH services as more integral to their practice. DIH nurses demonstrated a high degree of familiarity and comfort in counseling patients with CIH modalities. Qualitative data highlighted the importance of creating safe, therapeutic environments, empowering patients, and improving health literacy. Challenges included limited education, awareness, and staffing, particularly during evenings and weekends. Proposed improvements encompassed expanded education and staffing, dissemination of effectiveness criteria, and automated electronic health record referrals. Conclusion: CIH services are broadly perceived as health-promoting and warrant expansion, but operational and cultural challenges must be addressed. These findings will guide CIH services' refinement in U.S. academic medical centers and serve as a model for institutions seeking to integrate CIH services into patient care.

Aim: This study aimed to examine the effects of foot baths applied during the active phase of labor on labor pain and childbirth comfort in nulliparous women. Method: This randomized controlled clinical study was conducted at a maternity hospital in Turkey between February and July 2024. The sample consisted of 196 primiparous women at 37-42 weeks of gestation, with a cervical dilation of at least 4 cm and a cephalic presentation. Participants were randomly assigned to the intervention (n = 98) and control (n = 98) groups. In the intervention group, participants received two 20-min foot baths at 4 cm and 9 cm cervical dilation. Data were collected using a personal information form, the visual analogue scale to assess labor pain, and the Childbirth Comfort Questionnaire to assess childbirth comfort. Results: Labor pain was the primary outcome, and childbirth comfort was assessed as a secondary outcome. The intervention group reported significantly lower labor pain levels compared with the control group (p < 0.001). However, no significant differences were observed between the groups in the physical, psychospiritual, or environmental dimensions of comfort, nor in the total childbirth comfort scores (p = 1.000). Participants were continuously monitored for any adverse events, including discomfort, skin reactions, or circulatory symptoms; however, no such events were reported during the intervention. Conclusion: Foot baths may contribute to reducing labor pain and possibly shortening the second stage of labor. However, given the multidimensional nature of childbirth comfort, interventions focusing solely on physical relaxation may not address all aspects of comfort. Therefore, integrating physical relaxation practices with psychosocial and environmental support is recommended, and further research is needed to confirm these findings.

Introduction: Indonesia's health care system requires transformation to address its aging population and rising chronic diseases. Medical acupuncture presents a holistic, cost-effective solution but faces integration barriers, including stigma, lack of local research, and absence of educational and regulatory frameworks. The objective of this study is to analyze barriers and opportunities for the integration of medical acupuncture into Indonesia's national health system and to propose strategic steps for developing a standardized curriculum, legal regulation, and interprofessional collaboration to ensure safe and evidence-based implementation. Methods: A literature review was conducted using PubMed, ScienceDirect, and Scopus. Keywords included "acupuncture," "education," "regulation," "medical policy," and "public health." The analysis focused on studies examining integrative medical acupuncture practices in various countries. Results: Comparative analysis revealed that successful integration, as seen in China and Australia, depends on standardized education and clear regulations, ensuring practitioner competence and patient safety. Conversely, nations with fragmented regulations, such as India and Brazil, face quality control challenges. Medical acupuncture demonstrates proven efficacy across the health care spectrum, including pain management, rehabilitation, and palliative care. Discussion: For Indonesia, strategic integration requires two key actions: developing an undergraduate medical acupuncture curriculum and establishing a formal legal framework for its practice. This will provide professional legitimacy, ensure patient safety, and curb illegal practices. These steps must be supported by enhanced interprofessional collaboration with conventional medicine, international partnerships, and increased funding for local evidence-based research. Conclusion: Integrating medical acupuncture is vital for a sustainable Indonesian health care system. Prioritizing a standardized curriculum and formal regulation will ensure its safe and effective practice. Supported by research and collaboration, this integration will expand access to affordable, holistic, and evidence-based care for the population.