Global advances in integrative medicine and health最新文献

Introduction: Hypertension is increasingly recognized as a biopsychosocial condition influenced by psychological distress and systemic inflammation. The potential of integrative mind-body approaches such as Heartfulness meditation and yoga to offer non-pharmacological benefits through neuroendocrine and immunomodulatory pathways is a source of hope and optimism in the field.

Objective: To evaluate the effects of a 12-week Integrated Approach of Heartfulness-based Yogic Practices and Meditation (IAHFNM & YP) on psychological distress, inflammatory cytokines and stress biomarkers in individuals with prehypertension or Stage 1 hypertension.

Methods: In this randomized controlled trial participants were allocated to either the intervention group (IAHFNM and YP) or the standard care group. Psychological distress was assessed using the Brief Symptom Inventory-18 (BSI-18). Blood samples were analyzed for cytokines (IL-6, IL-1β, TNF-α, IL-10, IL-18) and neuroendocrine stress markers (copeptin and corticotropin).

Results: The intervention group showed significant reductions in psychological distress, including anxiety, depression and somatization, as reflected by a marked decline in the Global Severity Index (P < .001). This reassures us about the study's effectiveness. Inflammatory biomarkers IL-6, IL-1β, and TNF-α significantly decreased (P < .05), while anti-inflammatory IL-10 levels increased (P < .001). Stress-related biomarkers copeptin and corticotropin also showed significant reductions (P < .001), suggesting downregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Although correlations between psychological scores and biomarkers were modest (R² < 0.12), corticotropin showed the strongest association with BSI-18 scores (r = 0.389).

Conclusion: The findings demonstrate the efficacy of Heartfulness in improving psychological well-being and modulating inflammatory and neuroendocrine markers in prehypertension and hypertension. These results support integrating mind-body practices into hypertension management. However, small sample size, limited duration, and reliance on self-reported adherence may affect generalizability. Future studies with larger cohorts, objective adherence measures, and extended follow-up are recommended to establish sustainability and underlying mechanisms.

Background: Pediatric patients with chronic illnesses face a multitude of health challenges that are often inadequately addressed by conventional, siloed medical systems. Pediatric integrative medicine (PIM), blending complementary therapies with conventional medicine, offers an interdisciplinary and comprehensive approach to addressing these complex challenges. Despite growing demand for PIM, lifestyle-oriented care, and multimodal biopsychosocial interventions, few studies have described the clinical delivery of PIM within a large academic medical center.

Objectives: To describe the demographics, clinical characteristics, and interventions utilized within a physician-led, PIM clinic at a large, pediatric academic medical center.

Methods: A retrospective review was conducted of 2677 outpatient PIM physician office visits (March 2020-September 2023) among 657 pediatric patients (birth-25 years). Data on demographics, diagnoses, interventions, and supplements were extracted from the electronic health record and summarized using descriptive statistics.

Results: Patients (mean age 12.24 ± 5.20 years) were predominantly female (56%) and White (68%). Common conditions included anxiety (59.2%), fatigue (44.4%), headache (43.1%), abdominal pain (33.6%), constipation (33.0%), nausea (31.7%), vitamin D deficiency (30.1%), myofascial pain (29.5%), and depression (26.8%). Key intervention recommendations included dietary changes (61.8%), myofascial self-care interventions (33.8%), massage therapy (21.0%), acupuncture (19.2%), pacing (18.4%), sleep hygiene (18.3%), and exercise (18.1%). Common supplements recommended included probiotics (49.9%), vitamin D (42.6%), multivitamins (41.9%), fish oil (39.4%), magnesium (32.0%), Chinese herbs (29.7%), and melatonin (22.8%).

Conclusion: PIM can provide whole-person, integrative care within a large academic medical center for pediatric populations with complex presentations. Its self-governed structure within an academic medical center facilitates broad service integration, addressing demands for comprehensive care. Future practice-based research with standardized documentation and outcome measures is needed to understand PIM's clinical effectiveness.

Objective: To assess the acceptability of a randomized single-blind trial of cognitive behavioral therapy (CBT) and whole-body hyperthermia (WBH) treatment for major depressive disorder (MDD).

Methods: All participants (N = 30) with MDD received CBT for depression and were randomized to also receive either: (1) WBH that raised core body temperature using an infrared sauna device, or (2) sham WBH of a similar duration that did not significantly raise core body temperature.

Results: Study acceptability was the primary outcome: of participants who completed the final assessment (n = 29; 96.7%), 22 (75.9%) reported that they would recommend participation to a friend or family member with MDD. Twenty-five (86.2%) participants reported that they would be likely or extremely likely to enroll in this study, given the experience they had in the study. All participants randomized to WBH correctly believed they received WBH, and 6 (43%) of participants randomized to sham WBH correctly believed they received sham WBH. Both arms achieved clinically meaningful and statistically significant reductions in depression symptoms. The average decreases in the Beck Depression Inventory-II (BDI-II) were -19.07 (SE = 2.69, P < 0.0001) in the WBH arm (80.0% no longer meeting DSM-5 criteria, 60.0% achieving 50% or greater reduction in BDI-II) and -21.10 (SE = 2.41, P<0.0001) in the sham WBH arm (92.9% no longer meeting DSM-5 criteria, 78.6% achieving 50% or greater reduction in BDI-II).

Conclusions: Study procedures were acceptable. Participants in the WBH and sham WBH groups had substantial reductions in depressive symptoms that were greater than typically seen with CBT alone. The sham WBH arm was not fully credible and may have exerted antidepressant effects, thus raising concerns about its use in future trials. Further research to test whether adding WBH to CBT results in additional antidepressant effects is warranted.

Background: Finger exercise is a mind-body practice rooted in Traditional Chinese Medicine (TCM), grounded in meridian and acupoint theory. It consists of coordinated finger and hand movements, massage, and pressure techniques that stimulate the flow of Qi and improve circulation, strengthen hand-brain connectivity, and cultivate mindfulness. Finger exercise is intended to promote physical health, enhance cognitive function, and support mental well-being.

Objective: To introduce the concept of finger exercise, synthesize emerging evidence on its effects on general, physical, cognitive, and mental well-being, and explore potential mechanisms and implications for research and practice. A preliminary framework was developed based on initial evidence.

Methods: We conducted a literature search of randominzed controlled trials across three English and two Chinese databases using search terms such as "finger exercise" combined with keywords related to health, cognition, depression, anxiety, and sleep. A total of 12 studies published in English or Chinese (with English abstracts) were included in this review.

Results: The reviewed studies reported varied intervention protocols incorporating TCM principles, brain-hand coordination, pressure techniques, and mindfulness-based strategies. Preliminary evidence suggests that finger exercise may improve general functioning (eg, ADL/IADL), physical indicators (eg, fatigue, sleep), cognitive performance, and mental health (eg, depression, anxiety). Potential mechanisms include enhanced Qi flow, neuroplasticity, neurotransmitter modulation, reduced inflammation, and improved mindfulness.

Conclusion: Mindfulness-based finger exercise shows promise as a low-cost, safe, and easily implemented non-pharmacological intervention that can be done standing or seated and is also suitable for individuals with disabilities or mobility limitations. It has a potential to be integrated into community centers, nursing homes, hospitals, and rehabilitation programs. Further research should confirm its benefits and clarify mechanisms.

Background: Increased stress in healthcare workers (HCW) is a global crisis and few brief, scalable interventions exist to support HCW with stress, anxiety, and insomnia. Individual interventions impacting these multiple symptoms are needed.

Objective: To determine whether a noninvasive brainwave echoing acoustic neuromodulation intervention reduces perceived stress among HCW compared to waitlist control.

Methods: This was a parallel randomized controlled trial of acoustic neuromodulation vs waitlist control conducted at a large academic health system. Adult HCW with Perceived Stress Scale (PSS) ≥14 were included. Exclusions were factors that would compromise intervention delivery or current engagement with similar interventions. The intervention was a limited dose paradigm of Cereset Research™ Standard Operating Procedures, a noninvasive, closed-loop, brainwave echoing acoustic neuromodulation neurotechnology, composed of four, 36-minute acoustic neuromodulation sessions over 2 weeks. The primary outcome was change in PSS at 6-8 weeks. Secondary outcomes were anxiety (Generalized Anxiety Disorder-7) and insomnia (Insomnia Severity Index). Exploratory outcomes included validated measures of depression, fatigue, and subjective cognition. Group-level changes in outcomes were evaluated using linear mixed models.

Results: Of 144 participants (72 per group), 134 completed primary outcome assessment (67 per group). Participants had mean age 44.7 years [SD 11.6] and were 86.1% female (N = 124). Intention-to-treat analyses demonstrated mean PSS score reduction of 7.8 (SD 5.9) in the intervention group vs 1.2 (SD 4.1) among controls (difference between groups 6.6 points, 95% CI 4.9-8.2, P < 0.0001). Secondary and exploratory measures also demonstrated significant group-level improvements in intervention vs control, and there were no serious adverse events.

Conclusions: In HCW with elevated stress, acoustic neuromodulation resulted in clinically meaningful improvements in perceived stress, anxiety, and insomnia. The intervention is safe, scalable, and may merit adoption by health systems to complement organization-level approaches for enhancing HCW well-being. Trial Registration: ClinicalTrials.gov, NCT04682197.

Background: Complementary and integrative health (CIH) services enhance physiological and psychological wellbeing, while potentially reducing medical costs. Despite these benefits, use of inpatient CIH services remains poorly characterized, impeding efforts to develop equitable and effective healthcare.

Objective: This retrospective case-control study examined characteristics of patients likely to receive CIH referrals and consults.

Method: Electronic health records were analyzed from patients hospitalized at a large metropolitan academic medical center from September 2022 to February 2024.

Results: Referred patients (n = 3491) were less frequently male, Asian American, non-English-speaking, and more medically complex compared to non-referred patients (n = 6982, P values <0.001). Among those referred, 72% received at least one CIH consult, with lower odds of completing a consult for male patients.

Conclusion: Disparities underscore the need for equitable CIH services access in healthcare systems. Future research will test how to broaden services to male patients, those with non-English language preference, and less medical complexity, to ensure greater benefit from holistic healthcare.

Background: Triphala, a classical polyherbal formulation in Ayurvedic medicine, has traditionally been used for its diverse therapeutic properties, particularly its antioxidant, anti-inflammatory, and immunomodulatory effects.

Objective: This study aimed to evaluate changes in oxidative stress, antioxidant activity, and systemic inflammation following Triphala supplementation in individuals with post-COVID-19 condition.

Methods: Seventy-four participants (aged 18-53 years) with a history of COVID-19 were enrolled in a preliminary randomized, double-blind, placebo-controlled trial. Participants were randomly assigned to receive either placebo (n = 37) or Triphala (1000 mg/day; n = 37) capsules, taken 5 days per week for 8 weeks. Biomarkers assessed included malondialdehyde (MDA), protein carbonyl, superoxide dismutase (SOD), interferon-gamma (IFN-γ), and tumor necrosis factor-alpha (TNF-α), measured before and after supplementation.

Results: In the Triphala group, MDA (P = 0.026), protein carbonyl (P = 0.017), IFN-γ (P = 0.038), and TNF-α (P < 0.001) levels significantly decreased, while SOD activity increased (P = 0.008). In the placebo group, only SOD activity showed a significant increase (P < 0.001). However, no statistically significant differences were observed between the two groups in any of the primary outcomes.

Conclusion: Triphala supplementation may help reduce oxidative stress and systemic inflammation in individuals with post-COVID-19 condition. Future studies with higher doses or longer treatment durations are recommended to confirm and extend these findings.

Whole person health care offers a number of potential benefits including better health outcomes for patients, decreased health care utilization, and lower overall costs of care. With its emphasis on health promotion and disease prevention, whole person health also has great potential to help align health care with planetary health by decreasing both direct and indirect environmental impacts associated with conventional medicine. In addition, by emphasizing plant-based and plant-forward nutrition, active transportation, mindfulness, and nature connection, whole person care is poised to contribute to the societal transformation needed to overcome the planetary health challenges we face. This essay, in response to the recent article Making the Case for Whole Person Health, provides an overview of the bi-directional connections between health care and planetary health, and emphasizes how whole person care offers a pathway forward for the health care industry that is better for both people and the planet.

Background: Online yoga offers significant potential for healthcare systems. As efforts to incorporate online yoga in healthcare settings have grown, research in this area has mostly focused on the perspectives of patients and clinicians. Although yoga teachers are crucial to the implementation and delivery of telehealth yoga (tele-yoga), their views on this topic have not yet been adequately considered. This study examined the perspectives of Veterans Health Administration (VA) yoga teachers regarding a VA Office of Rural Health-funded multi-site tele-yoga implementation study.

Objectives: This qualitative study aims to explore VA yoga teachers' perspectives and experiences with regards to implementing and delivering synchronous, remote, group yoga-for-wellness classes via video-based telehealth and provide lessons learned.

Methods: A qualitative study was conducted with 13 yoga teachers from 6 different VA healthcare systems included in a multi-site tele-yoga implementation study. Interviews covered experience with teaching in an online format, program implementation and delivery, and equity considerations. Interviews were conducted and recorded using Microsoft Teams. Transcripts were coded using MAXQDA 2022 and analyzed via thematic content analysis.

Results: VA tele-yoga teachers identified 4 categories impacting tele-yoga implementation and delivery: (1) equipment and information technology needs; (2) physical space (particularly for teachers teaching onsite in a hospital or clinic setting); (3) accessibility and safety; and (4) administrative responsibilities and end-user support. Findings highlight key considerations and potential solutions for teachers and healthcare settings, and resources needed to provide a safe, accessible, and effective experience for participants.

Conclusion: Learning from tele-yoga teachers' experiences at VA can inform best practices for teaching yoga to groups in a synchronous, remote, online format within healthcare settings. The ways in which VA tele-yoga teachers surmounted barriers and harnessed opportunities for success can inform program recommendations as tele-yoga programs expand across VA and become incorporated in other healthcare systems and facilities.

Background and objectives: This study investigated a potentized, oral homeopathic SARS-CoV-2 nosode (BiosimCovex) for safety, efficacy, and immunogenicity against COVID-19 infection.

Methods: A phase III, multicentre, randomised, double-blind, placebo-controlled trial was conducted at 13 sites in India. 2671 unvaccinated, RT-PCR and SARS-CoV-2 antibody-negative participants were randomized 2:1 to receive 6 doses over 3 days of BiosimCovex (1781) or placebo (890). SARS-CoV-2 prevention efficacy was assessed through RT-PCR. Efficacy was defined as 100 x (1-IRR), where IRR is the ratio of positive RT-PCR test rates in the BiosimCovex compared to the placebo group. A two-sided Clopper-Pearson 95% confidence interval was adjusted for surveillance time. Immunogenicity was measured by SARS-CoV-2 antibody conversion at days 15, 30, 45, and 60. Safety was assessed through symptom questionnaires and laboratory studies every 15 days. Illness burden was assessed through symptom diaries.

Results: Maximum efficacy occurred at day 45 and was 50.06% overall, 71.88% in individuals aged 18-40 years; and 61.57% in females. By day 45, there were 23 positive RT-PCR cases per group (BiosimCovex 1.3%; placebo 2.6%, P = 0.007). A total of fifty-nine positive RT-PCR cases occurred, with thirty-three (1.86%) in the BiosimCovex and twenty-six (2.94%) in the placebo group, for a relative risk (RR) of 0.63 at the end of the study over 60 days. Antibody conversion increased over time, with 48.4% becoming antibody positive by day 60 in the treatment group compared to 13.4% in the placebo group (P < 0.001). All 169 (6.33%) mild adverse events resolved without sequelae (6.52% in treatment; 5.96% in placebo). There was a significant reduction in symptom duration (P = 0.0085) in the treatment group for those who became ill.

Conclusions: A potentized oral nosode was safe and appeared to prevent SARS-CoV-2 infection and be immunogenic over 60 days. Effectiveness was highest at day 45 in females and in the 18- to 40-year-old age group.