Global advances in integrative medicine and health最新文献

Background: Racial and ethnic disparities in healthcare in the United States have been well described. Despite the growing presence of Chinese patients in the U.S. healthcare system, medical education largely lacks formal training in Chinese cultural sensitivity and traditional Chinese medicine (TCM). This study aims to explore physician experiences and identify strategies for delivering elucidate themes in physician experiences and identify strategies for delivering culturally sensitive, equitable care to ethnically Chinese patients living in America.

Methods: A qualitative study was conducted using purposive and snowball sampling, with semi-structured interviews with 7 academic and 12 community physicians in Southern California who met the following criteria: (1) general practice or community physicians with >25% of their patient population being ethnically Chinese or (2) specialists working with >10% ethnically Chinese patients at any of their medical practices.

Results: Physicians reported significant cultural differences in patient-provider relationships, family involvement in medical decision-making, communication styles, perceptions of biomedical and integrative therapies, and attitudes toward sensitive health topics. A majority of participants observed that many ethnic Chinese patients use TCM alongside conventional treatments but often do not disclose this to their physicians. Recommendations for improving culturally sensitive care included increasing the availability of Chinese-speaking providers, incorporating structured exposure to ethnic Chinese patients in medical training, and offering formal education on Chinese language, health beliefs, and TCM principles for healthcare professionals.

Discussion: Physicians highlighted the need for systems-level, educational, and individual-level interventions to mitigate health disparities in Chinese American communities. Integrating physician perspectives on cultural health practices into medical education and clinical training may enhance patient trust, improve adherence to treatment, and bridge gaps in culturally sensitive care for ethnically Chinese patients in the United States. Furthermore, acknowledging and incorporating TCM in patient-centered care could foster a more holistic and culturally congruent healthcare approach.

Background: While some evidence suggests psychosocial and physical health benefits of Bharatanatyam (eg, Indian Classical Dance), no study has explored the lived experiences of Bharatanatyam dancers themselves and the value they place on this practice for their own well-being.

Objective: Using a qualitative methodology, the purpose of this study is to explore Bharatanatyam dancers' perceptions of this practice and its impact on their lives.

Methods: Bharatanatyam dancers with at least 10 years of experience participated in a 60-minute recorded Zoom interview about their experience, history, and relationship with Bharatanatyam, with a focus on how it may have impacted their well-being. Using a Grounded Theory approach, research team members engaged in open coding to create an initial codebook from the first transcript, and then took an interrater reliability test (Kappa >.70) before coding subsequent transcripts. Group-based axial coding was used to create higher-order categories and themes from the original codes. Saturation was documented.

Results: In total, 15 Bharatanatyam dancers were interviewed, resulting in 206 unique codes. Saturation was met for 82% of the codes. Axial coding yielded 27 higher-order categories, and five overarching themes: (1) "Foundations of Bharatanatyam", which highlighted important aspects of the practice (2) "Heightened Connections" across emotional, spiritual, community, and cultural areas, (3) "Improvements in Mind/Body/Spirit" highlighting increased emotional, physical, cognitive, and energetic wellbeing, (4) "Motivations and Challenges for the Practice" such as perceived benefits and practice barriers, and (5) "Processes of Practice" highlighting the dynamic and stylistic nature of the art form.

Conclusion: This study offers evidence that Bharatanatyam plays a role in a dancer's well-being through heightened connection and improvement in physical and mental health; knowledge which can help transform its role from a mere artform to a creative healthcare modality.

Background: Slow breathing exercises have been shown to reduce blood pressure and sympathetic tone acutely, though long-term effects are not well documented.

Objective: Assess changes in blood pressure and autonomic measures from before and after 12 weeks of yoga-based slow breathing.

Methods: We conducted a secondary analysis to assess changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and autonomic tone as measured by spectral analysis of heart rate variability after 12 weeks of yoga-based slow breathing among 99 healthy participants. Participants were randomized to 2 different slow breathing techniques, length of inhale = exhale (I = E) vs length of inhaleI), to examine if breath ratio produced differential effects.

Results: The baseline average SBP and DBP was 105 ± 11 and 67 ± 8 mmHg respectively. Among the 11 participants with elevated blood pressure, SBP/DBP was 126 ± 11.0/80 ± 5 mmHg. SBP and DBP decreased significantly (-2.4 ± 7.3 and -1.6 ± 5.5 mmHg, respectively) at 12 weeks among all participants. Blood pressure among slow breathing participants with elevated baseline SBP >120 mmHg and/or DBP >80 mmHg reduced further (-10.3 ± 7.9 and -3.8 ± 5.5 mmHg, respectively). In our regression model, baseline SBP was associated with further decreases in SBP from baseline to 12 weeks. There were no significant differences in BP changes by breath ratio group. No significant changes were observed from baseline to 12 weeks in autonomic tone as measured with spectral analyses. Nor were there any observed correlations between changes in blood pressure and autonomic tone.

Conclusion: 12-weeks of slow breathing exercises were associated with clinically significant reduction of blood pressure in the absence of statistically significant changes in autonomic tone as measured by heart rate variability. Further research is warranted regarding the mechanisms and clinical efficacy of slow breathing on blood pressure regulation.

In the 1980s, H. Pylori was discovered as the root cause of peptic ulcer disease and revolutionized treatment. Previously, this illness was treated as a somatoform illness, associated with Type A personalities. Similarly, there is now overwhelming evidence that the root cause of IBS (Irritable Bowel Syndrome) originates from the development of bacterial dysbiosis, yet diagnosis and treatment are not routinely offered to patients. Instead, patients are offered palliative measures. A paradigm shift for IBS management is urgently needed.

Background: Therapeutic music has been shown to reduce stress and anxiety, while boosting mood and overall well-being in numerous settings. Building on the success of Vanderbilt University Medical Center's (VUMC) Therapeutic Music Program, and in collaboration with AARP Tennessee and the Blair School of Music at Vanderbilt, a community-based therapeutic music program was introduced, focusing on community assisted living centers and Veteran audiences.

Objective: To evaluate the experience and perceptions of Veteran and senior citizens to live therapeutic music performances in order to guide future program development and music selection.

Methods: Performances were held at a local Veterans Affairs Medical Center and assisted living facilities, involving 42 participants. Student musicians performed music pieces with violin, piano, saxophone, and vocals. After each performance, audience members completed an anonymous survey.

Results: Survey results revealed that 93% (n = 39) of participants recognized music as a significant or moderately significant part of their lives. Most participants enjoyed a wide variety of instruments and genres (60%, N = 24). Participants appreciated the live performance, vocal pieces, and the atmosphere it created.

Conclusions: Data on preferred genres and instruments can guide the selection of musicians for other therapeutic programs. Furthermore, insights into the most enjoyable parts of the performance can inform customization of future music performances to help better address the needs of different audiences.

Low back pain (LBP) is one of the leading causes of disability globally. The prevalence of chronic LBP has increased dramatically, and there is a need for conservative therapeutic interventions to support patients with chronic LBP. A 66-year-old female patient presented with severe low back pain and associated disability of 2 years' duration. The patient received 8 weeks of Ayurvedic treatment. The Oswestry Disability Index score and self-rated pain on a scale from zero to ten were used to assess disability and pain over time. The patient reported a considerable reduction in LBP over the course of the Ayurvedic intervention, and her disability score improved from 55% at the initial consultation to 20% at the end of treatment. This case report suggests the potential of an Ayurvedic approach as a complementary and alternative treatment method for chronic LBP. Larger, controlled interventional studies are needed to further evaluate the effectiveness of Ayurvedic protocols for the management of chronic LBP.

Background: Integrative health efforts typically offer clinical services of Western and non-Western origin in a biomedical context. Indigenous communities and other minoritized populations would benefit from improved equity efforts in integrative healthcare.

Objective: As an approach to improve healthcare for Kānaka 'Ōiwi (Native Hawaiians), we explore multi-eyed seeing, an elaboration on two-eyed seeing, emphasizing decolonialism and adaptive use of healing traditions from multiple cultural backgrounds. We also discuss the ways multi-eyed seeing may be used to address challenges to integrative health inequities.

Methods: Using the transformative paradigm and community-based participatory action research, we conducted 1 focus group and 38 in-depth interviews. Data were analyzed using grounded theory, a decolonial intersectionality method, ho'omana i nā leo (empowering the voices), and thematic analysis. To triangulate data, recruitment targeted 3 categories: mental and behavioral health providers who primarily serve Kānaka 'Ōiwi (n = 12), Kanaka 'Ōiwi clients who experienced depressive symptoms (n = 19), and Kanaka 'Ōiwi cultural leaders (n = 10).

Results: Three primary themes emerged, suggesting that multi-eyed seeing: 1) supports Indigenous wellbeing at multiple levels; 2) necessitates unique spaces for healthcare and healing; 3) may illuminate similarities across cultures and underlying mechanisms for healing and health. Findings also include 2 secondary themes, 1 describing the potential role of multi-eyed seeing in idiographic and transdiagnostic approaches to behavioral and integrative healthcare and another describing potential barriers to multi-eyed seeing.

Conclusions: By drawing upon strengths of Indigenous, Western, Eastern, and other pathways to wellbeing, a synergistic weaving may be stronger than the sum of its parts. At the levels of ontology, epistemology, axiology, and praxis, multi-eyed seeing provides approaches to equity in integrative healthcare. We offer critical reflections and analyses of the processes that may uplift the work of multi-eyed seeing as a decolonial approach and invite dialogue around this concept for future exploration.

Background: Myasthenia gravis (MG) is a rare autoimmune disease resulting in muscle weakness. Although pharmacologic treatments are typically effective at managing symptoms, prolonged use is associated with safety issues. Acupuncture treatment may have a significant positive effect in treating MG symptoms and may enhance the efficacy of medications.

Objective: The overall goal was to examine the feasibility and safety of a pilot randomized controlled trial of acupuncture treatment in individuals with MG.

Methods: Participants were randomized into 2 arms: (1) immediate start and (2) delayed start. Participants in the immediate start arm underwent twice weekly acupuncture for 12 weeks, whereas participants in the delayed start arm underwent a 12-week delay period, followed by twice weekly acupuncture for 12 weeks. A base treatment of 21 acupoints was used for all study participants. Acupuncturists made a Traditional Chinese Medicine differential diagnosis to determine whether the patient was yang deficient, yin deficient, or stagnation pronounced, and could add up to 9 additional acupoints. Participants received the same acupuncture protocol for all 24 treatments.

Results: Twenty-four individuals with MG were enrolled in the study. The average age of participants was 62 (SD = 13) with an average of 8 years (SD = 9) between diagnosis and enrollment. Seventeen of the 24 individuals who signed the consent form completed 100% of acupuncture treatment sessions and completed the full study. Only 17 adverse events were determined to be definitely or probably related to treatment, which were mostly mild site reactions. Barriers to participation included transportation issues, travel time, and the overall time commitment.

Conclusion: The results demonstrated that acupuncture treatment was overall feasible and safe in individuals with MG. Participants also self-reported improvements in MG symptoms. Next steps will include development of an efficacy RCT with a rigorous study design to examine the clinical significance and efficacy of acupuncture for MG.

Background: Ayurveda Prakriti determines individuals' physical, physiological, and psychological features. Prana-the vital life energy-flows throughout the body and is intimately linked to the tridosha.

Objectives: This pilot study aims to explore the relationship between tridosha and the intensity and distribution of Pranic Energy Sensations (PES), along with physiological parameters and mental well-being.

Method: This single-arm pilot study was conducted at a Government Ayurveda Medical College, Mysuru, Karnataka, India, using convenience sampling. Data collection encompassed demographic details, the Dosha self-assessment questionnaire, Positive State of Mind Scale (PSOMS), and physiological parameters including Body Mass Index (BMI), Peak Expiratory Flow Rate (PEFR), oxygen saturation (SpO₂), and temperature. Following Sensitizing the Hands Practice (SHP) and Energising Prana Technique (EPT), the intensity and distribution of PES in the palms were recorded and analyzed.

Results: Ninety-one apparently healthy Ayurveda students with a mean age of 24.86 ± 2.32 years participated. Exploratory correlations suggested that PES intensity had a positive correlation with Body Vata (ρ = .224, P ≤ .05) and Pitta (r = .209, P ≤ .05). Mind Vata showed a negative correlation with Positive State of Mind (ρ = -.373, P ≤ .01). Body Vata also showed correlations with forehead temperature (pre: ρ = .282; post: ρ = .348, P ≤ .01), and Body Kapha with PEFR (ρ = .206, P ≤ .05). A small to moderate reduction in temperature was observed post-EPT.

Conclusion: This pilot study identified an association between higher PES intensity and Body Vata and Pitta dominance among Ayurveda students, suggesting a potential link between PES, Prakriti, physical parameters and psychological state. These findings align with Ayurvedic concepts connecting Vata and Prana, offering preliminary support for their relevance in biofield therapies. Further studies with control groups and objective validation are recommended.

Purpose: The purpose of this study was to understand homeless veterans' perspectives on the utility and impact of Battlefield Acupuncture (BFA).

Design: A qualitative study among veterans with chronic pain who were experiencing homelessness.

Methods and participants: A subset of twelve Veterans who participated in a in weekly BFA sessions for up to 12 weeks at one VA medical center participated in semi-structured interviews conducted between September 2022 and March 2023. Qualitative thematic analysis was used to analyze the data.

Results: The average number of BFA visits among participants was 10.8. Thematic analysis revealed three themes (1) Prior experiences with chronic pain, where Veterans often reported having pain for years with limited relief, (2) Appeal of a non-pharmacologic treatment, and (3) BFA had a positive impact on health and well-being. Overall, participants reported BFA to be a brief, convenient, and effective non-pharmacological treatment for their chronic pain. Many described how they had exhausted most other traditional treatments for their chronic pain and saw BFA as an acceptable and effective alternative treatment.

Conclusions: Our results indicated Veterans appreciated BFA as an alternative approach toward the treatment of their chronic pain beyond what is typically offered in conventional health care, the convenience of short appointment times, and accessible services. Our findings support the VA continuing to offer BFA as a Complementary and Integrative Health modality, particularly for high acuity populations like Veterans experiencing homelessness.